A lot the decision-making we do is around trying to improve the health outcomes for large populations of members at scale. When dealing with millions of members, interventions that require lots of effort and time are hard to scale up. If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.
There are other benefits to annual checkups as well - catching an expensive condition early can be the difference between a $100,000 episode of care vs. a $10,000 episode of care.
To be honest internally I've noticed the tide is shifting on annual checkups. Physician time is limited and every slot is valuable. I believe we're currently exploring virtual care options as a better alternative.
"Improving health outcomes" is corporate PR speak for "selling more insurance services." If you know the first thing about health insurance and capitalism, reading between the lines is easy. I can only assume you are not very familiar with these things. Frankly, every single minute of every single day at my job, the only thing myself or my colleagues worked on was generating more profit for the company we worked for. If customers ended up with better health, it was a side effect of the profit-making efforts and nothing else. Please learn to not believe every damn word someone says to you.
The statement is a bit of PR speak, but it's not made to sell more products. People working in healthcare generally do care about improving health outcomes.
If you knew the first thing about capitalism, you would know that what one "cares about" has only the most contingent relation to the end product of their labor. In other words, what the workers care about is effectively meaningless because the workers are not in charge; the profit is.
Nihilism aside you seem to have a deep misunderstanding of evidence based medicine. While cost is a consideration in population-level screening programmes you seem to be ignoring that it is balanced with benefit and is not decided by insurers but rather the USPSTF.
> what the workers care about is effectively meaningless because the workers are not in charge
The agency in charge of screening (USPSTF) takes the work-product of physicians and other health professionals (workers) researching and building evidence on health outcomes (what they care about) which establishes the standard of care that is then forced down by the government onto insurers.
On an individual level I can also advocate as a physician by recommend screening regimens to patients who's care I am involved in and force the insurer to pay, which is what we did for breast screening before the USPSTF caught up.
Sure if you want to take a reductionist view I am using profit (specifically the fear of liability) as a tool to force the insurer but that does not mean what I care about (reducing breast cancer deaths) is effectively meaningless.
There's no need for this tone (and similarly in your previous comment). From HN guidelines:
> When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3."
But probably there are a ton of scenarios where profit is anti-aligned with patient outcomes and the decisions are made still to maximize profit.
I can believe that. Not because people are wicked, but collective behaviors behind the system favoring profits more than patient outcomes. The system is extremely complex and even small biases somewhere deep can possibly have a big swing in the outcomes.
> But probably there are a ton of scenarios where profit is anti-aligned with patient outcomes and the decisions are made still to maximize profit.
It may align in their financial interests for most of these required preventive services[0] but there are some that very obviously don't like lung cancer (it would be cheaper to let smokers die quickly than to put them on immunotherapy + SBRT) and others with weak evidence, I doubt a good cost-benefit analysis has been performed for weight counseling.
Point being is that insurers are not the final say in a lot of this, the ACA did add a lot of requirements for them. But I concede there are times they don't, OP is just being overly harsh here and "improving health outcomes" isn't an insurance-specific PR line it has been used in academia and the government for a while now, even in public health systems.
That or it's yet another example of selection bias. There have been so so many things like this where the epidemiological data shows a correlation with health, but there isn't actually a causal link. For example, annual checkups might correlate with better health because it's a more common behavior among people who can afford to do it, and wealthier people tend to be healthier.
https://www.hhs.gov/healthcare/about-the-aca/preventive-care...
For example, a lot of the research that we are reading (including possibly the article we’re responding to) is the result of funding created by the ACA.
My favorite aspect of it is the massive push to digitization which means handwritten prescriptions have pretty much been eliminated removing an entire class of death and disease causing errors (from pharmacists misreading doctors’s handwriting).
Anyway, our government continues to denounce as "authoritarian and oppressive" the tiny socialist island nation of Cuba that built an incredibly impressive health system that exports doctors (such as to Italy at the start of the ongoing pandemic) when they can't even get metal for syringes b/c of U.S. sanctions.
* For a striking example, Rick Scott was Gov. of Florida, now Senator. He was able to do this because he was rich. He got rich by scamming the hell out of Medicare. https://www.newsweek.com/rick-scotts-connection-massive-medi...
In the case of annual checkups, I believe insurance companies are required to cover them 100% by the Affordable Care Act:
https://www.hhs.gov/healthcare/about-the-aca/preventive-care...
The only way to guarantee a free annual checkup is to go in, say nothing about your state of health, let the dr take your vitals and leave.
In previous annual checkups with my primary care doctor, I have mentioned symptoms as varied as:
- recent depression
- trouble breathing
- irregular heartbeat
several of which resulted in follow-up appointments / lab work, but all of which were still covered 100% as annual checkups.
If you can find a doctor that takes your ACA plan then anything other than checking for a pulse is likely to result in some sort of bill.
https://www.kff.org/report-section/2018-employer-health-bene...
And I have never had a doctor not accept an ACA compliant plan, which have been in the BCBS network for me.
This website seems to have a decent summary of coverage rules:
https://www.verywellhealth.com/aca-compliant-health-insuranc...
https://www.verywellhealth.com/preventive-care-whats-free-wh...
If your employer provided insurance it's good insurance, that's the perk of working there and part of your compensation.
If your employer doesn't provide it you have to buy during open enrollment through the exchange and the plans are terrible and expensive.
If you bring up a complaint, it's no longer a preventative check-up, it's addressing a complaint, which has a different billing code and different reimbursement.
s/better/cheaper/
It isn't hard to see how something that might not be in the insurance company's best interest could be in owners best interest, particularly if the own the hospital too.
On the other hand, insurers probably have better actuarial data because of annual checkups and can better align their profit margins with fees. Thus reducing their own reinsurance fees.
Imagine you are an insurer and advise free annual checkups. Some of your patients don't bother. Those patients have a higher mortality. You conclude the annual checkup is good.
But you might be deceiving yourself - the kind of people to ignore health advice about getting an annual checkup might also be the kind of people to ignore the health advice on the back of a cigarette packet...
I'm not aware of insurance companies being too keen on getting into medical experiments like 'people with a birthday on a Thursday don't get the free annual checkup'.
If I bring up any health issues I'd like to discuss at my annual exam, it's billed as a doctor visit because it's no longer "preventative" care. For the visit to be free, I have to stay silent. It also gives providers an opportunity to recommend and order expensive tests or procedures that the patient might otherwise not have pursued.
They tried to bill me for that in the past at practices I was a patient of. There's a fine line between preventative care and E/M. You can generally walk the "preventative care" line by presenting your concerns as an observed change to be documented rather than a problem to be solved.
If they do charge you, call the office to appeal the billing and they generally drop it as long as you can push the point that you weren't seeking a specific treatment but rather were just informing the doctor of a change in your health or conditions since the last visit.
But yeah at big practices good luck. They are a living nightmare to deal with and I feel for anyone who can't get access to a smaller (ideally solo) practice.
https://www.nytimes.com/2022/10/08/upshot/medicare-advantage...
Sure, they could prefer healthy customers, or they could select for lower risk populations. The latter is easier.
So instruction following and hoop jumping are the sorts of test that won't improve health incomes, but will select for good customers.
how are insurance companies (in the US) supposed to achieve this, when it is generally acquired through an employer?
If even 10% of those who get an annual checkup succeed in losing weight when the doctor recommends they do so, it's a win.
One would assume they would not want to pay for unnecessary tests for healthy people.
So either their own research shows they save money with annual checkups in spite of what the article says, or more sinisterly, they do want to spend money to be able to justify higher premiums, because in several states they are required to spend around 80% of the premiums, and this is one easily plannable way.
Does anyone know? Perhaps someone working for an insurance company?