Consumer Driven Care: Should Reimbursement be tied to Personal Health Behavior

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The healthcare system in America is rapidly changing. Provision four of the American Nurses Association’s (ANA) Code of Ethics for Nurses with Interpretative Statements, “the nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and provide optimal care”. Therefore nurses need to grow and adapt their practice to meet the ever-changing environment. The hybrid insurance system in America is complex and dynamic, but ultimately financially driven. With healthcare costs in America rising as a result of chronic health conditions including obesity, there is a push for primary preventative care by insurance companies to improve health. Obesity will be focused on throughout this paper since obesity is an epidemic in America. In 2015-2016, the prevalence of obesity was 39.8% or 93.3 million Americans. The estimated annual medical cost of obesity in America in 2008 was $147 billion.

On average, the medical costs for people who have obesity is $1,429 higher than those of normal weight as a result of its related conditions including heart disease, stroke, certain types of cancer, and type 2 diabetes. Due to the lifestyle choices of Americans, in January 2017 the Centers for Medicare & Medicaid Center for Medicare and Medicaid Innovation Center designed the Value-Based Insurance Design (VBID) model. This was a method to improve the quality of care while also reducing the costs of chronic diseases for the individual. VBID can also be integrated into existing wellness programs such as ones already found in the workplace. Workplace wellness programs stemmed from years of employers citing unhealthy employee behaviors as a challenge to affordable insurance benefits. The idea behind both programs was to incentivize healthy behaviors by aligning the amount of health produced with the cost to the consumer. Reimbursement should not be tied to weight loss in obese patients because due to the lack of standardization, discrimination and unhealthy weight loss strategies are promoted, privacy is breached, and coercion is used.

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Looking at the ANA’s Code of Ethics for Nurses with Interpretative Statements, “the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities,” yet these programs promote discrimination. One of the main concerns employees have about these programs are that the questionnaires often ask about health risks or conditions that some may consider “sensitive”. For instance, whether or not you experience anxiety, stress, or depression, illicit drug use, alcohol consumption, information about current prescription drug use and other medical treatments, and, for women, whether they are pregnant or contemplate pregnancy in the coming year. Out of fear of discrimination in the workplace, information may not be accurately reported. In America, more than two million people live in a food desert. The U.S.

Department of Agriculture defines a food desert as “those urban areas that are more than a quarter mile from a supermarket that shelves healthy food choices”. As you can imagine, most individuals living in food deserts are economically disadvantaged and living below the poverty level.  This results in poor nutrition which can be directly linked to poor health conditions including obesity. What happens if you also add the factor of poor transportation and the fact that healthy food notoriously costs more? This can extend to access to healthcare and exercise facilities, or rather social determinants of health. Currently 40 million Americans live in poverty with nearly 20 million Americans classified as severely poor. In their book $2.00 a Day: Living on Almost Nothing in America, sociologists H. Luke Shaefer of the University of Michigan and Kathryn Edin of Princeton University said “the poorest Americans often struggle to find work, and many have to sell their blood plasma or hock possessions to raise cash for bus fare or a meal”. The reality is that people living in poverty are not likely to spend the few extra dollars they have at the end of the month on a weight loss method.

Think of Maslow’s Hierarchy of Needs, basic needs must be met first. If there is such a high correlation between poverty and obesity, are these programs just putting a Band-Aid on the obesity problem in America?  Besides lack of access, what about those who have a health condition such pregnancy for example where weight loss is contraindicated. Wouldn’t these programs essentially be penalizing those who don’t have access to the proper weight loss tools because they can’t participate? In over half of employers who participate in such programs require employees who do not participate to pay higher premiums compared to those who do participate.

There are plenty of methods to lose weight ranging from ones deemed healthy and unhealthy by healthcare professionals. One study showed that nearly one-fifth of people engaging in weight loss behavior over a year report participating in an unhealthy weight loss behavior. These behaviors include skipping meals or fasting to lose weight, doing a cleanse diet, taking weight loss pills/medicines/supplements/herbs prescribed or not prescribed by a doctor, engaging in excess exercise, taking laxatives, self-induced vomiting, and cigarette smoking. These are cardinal symptoms and indicate the risk of developing an eating disorder in the future. If one-fifth of people are already engaging in an unhealthy method of weight loss with no incentive attached, imagine how many would engage in one to lose weight fast. These programs are then essentially promoting weight loss through unhealthy methods and in the long run in unsustainable and could result in other heath conditions.

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Consumer Driven Care: Should Reimbursement be tied to Personal Health Behavior. (2022, Mar 17). Retrieved from

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