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.
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.