The real question is why the insurance companies are pushing the annual exams very hard, not just in consumer ads, but using lots of incentives for primary care physicians.
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?
I work at at a large health insurance company, though not involved in decision-making around annual exams or rate-setting so take that as you will.
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.
> 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.
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.
Here's a local study that try to provide some data - although I'm a little uncertain about the control with respect to yearly checkup (would you do yearly checkup on the control, then do nothing if you found cancer?).
Maybe I’m saying the most obvious thing ever, but with that last paragraph, you really make it sound like the American healthcare regimen is decided upon by the for-profit insurance companies.
Thanks for the link! That’s quite refreshing to hear. I didn’t realize the Affordable Care Act did so much more than ensuring availability of coverage and whatnot.
The ACA got a lot of headlines for a lot of BS but some of the really great things it did were very basic, under the radar items.
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).
While there are some regulations, it's basically a tug of war between business interests (insurance, hospitals, pharma, device manufacturers, testing companies, revolving door government agencies) that buy politicians and scam the government* and patients. No one would plan a health system this way, but planned economies (for the interests of regular people, not private equity) are "socialism" so we get to be the victims of life-or-death extortion rackets.
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.
Not OP, but I think the underlying meaning is that the focus on profit is primary. As in when it aligns with better patient outcomes it’s going to happen and that’s great.
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.
> Not OP, but I think the underlying meaning is that the focus on profit is primary. As in when it aligns with better patient outcomes it’s going to happen and that’s great.
> 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.
But that’s how the system is supposed to work! The goal of the insurance company is to reduce costs. The govt and the healthcare system are the parts of the system that advocate for the patient.
The groups driving "improving health outcomes" are not (just or even mostly) insurance companies but rather physician societies and government agencies like the USPSTF. We can also look to other national agencies from countries with publicly funded systems (Canada, UK, France, Australia) which share the same mission statement of "improving health outcomes" and have very similar screening recommendations as the US does.
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.
> 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.
What profit in public systems and with non-profit insurers is driving increased screening?
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."
> 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.
In the case of annual checkups, I believe insurance companies are required to cover them 100% by the Affordable Care Act:
Employer subsidized plans are also mostly compliant with ACA. Based on the trends in figure 13.3, I might even say less than 10% of Americans with employer subsidized health insurance are in non ACA compliant plans.
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.
I feel it's a kickback to the companies that provide care.
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.
> 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.
Oh yea just call and talk to someone its easy and its not like you are going to be put through the ringer talking to 10 different people over several weeks inexplicably over several continents.
I've not found that to be an issue with smaller practices. Most of the times small practices just have one person other than the doctor who deals with billing. Sure they often outsource past that but if you can get either the doc or that person, they'll often just change the codes because even if they can technically bill you, it's probably not worth the time or effort for them.
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.
Wild speculation is a combination of one insurance company offering it and it becoming a relatively low cost competitive bullet point on one hand.
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...
Sure, they understand the problem... But is there anything they can do about it?
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'.
There was a case here in New Zealand where the "not for profit" insurance company "Southern Cross" was owned by a group of doctors.
You can see how something that might not be in the insurance company's best interest could be in owners best interest, particularly if they own the hospital too.
My work offers free annual check ups and it’s mostly DIY. Prick of a finger, punch in weight, height and blood pressure into web app. Eventually once the results on the blood return, you get feedback on cholesterol etc. I get $500 from it and it is psychological to an extent - it helps encourage healthier habits
That's simply not how the medical insurance business works. Since the Affordable Care Act, insurers have almost no ability to pick and choose their customers. And since profit margins are capped there is like little incentive to "save" money by reducing medical expenses.
That's not true because they can pick and choose where and what to offer based on geographic areas through the ACA plans. But even more selectively they can offer group plans to employers that incentivize maintaining a healthy workforce. Most unhealthy people don't work good jobs that provide insurance.
Under the ACA, insurance companies have a profit cap as a percentage of expenditures, so they need to drive expenses to increase total profit (but still have to be competitive price-wise so it isn't unlimited).
Around here the insurance companies created a billing code that is just for annual checkups, with discussion of ongoing care turning it into a different type of visit (that isn't necessarily free).
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?