Charles Chieppo is a research fellow at the Ash Center of the Harvard Kennedy School.E-mail: Charlie_Chieppo@hks.harvard.edu
The next presidential election is more than a year away, but it's already clear that that the economy is the only issue likely to be more important than health care. While candidates argue over President Obama's federal health-care law or Massachusetts' overhaul under then-Gov. Mitt Romney, they might be better served to focus on local reforms that offer incentives for healthy lifestyle choices.
Officials in King County, Wash. (which includes Seattle), just announced that health care costs for the county's 13,000 employees would be $23 million—or more than 6 percent—less than anticipated this year. And next year, the savings are expected to grow to $38 million.
The savings are tied to the county's Healthy Incentives benefit plan, which was launched in 2005. The plan offers rewards to county workers who take steps toward healthier lifestyles, such as quitting smoking and losing weight. Employees get lower deductibles and co-pays if they take a health assessment, and out-of-pocket costs are further reduced for those who complete a 10-week action plan based on the assessment's results. The plans generally encompass physical activity, nutrition, and weight and stress management.
Under Healthy Incentives, the number of county employees who smoke is down 40 percent. And 2,000 employees in the weight-management program collectively have have lost 24 tons.
Manatee County, Fla., unveiled its YourChoice Health Plan, which takes an approach similar to that of Healthy Incentives, in 2004. Between fiscal 2008 and 2009, while national health-care costs increased by an average of more than 6 percent, Manatee's employee health-care costs declined by 6.6 percent. And cost-reduction statistics don't capture productivity increases from reduced absenteeism.
In addition to sliding co-pays and deductibles, YourChoice rewards employees with "Healthy Bucks" for making lifestyle choices such as not smoking, exercising and achieving and maintaining a healthy weight. The Healthy Bucks can be used to reduce medical and dental premiums or they can be placed in an employee's health-care spending account.
YourChoice's success hasn't made county officials complacent. For example, faced with data showing that depressed people are more likely to develop Type II diabetes and that employees suffering from depression and stress utilize the health-care system at a 250 percent higher rate, Manatee added a mental-health component in 2007. During that initiative's first year, the county saw an 8 percent decrease in pharmacy claims for antidepressants. When an emotional-eating component was added to the weight-management program, the total amount of weight lost jumped by 50 percent.
Political campaigns naturally gravitate toward ideological issues such as the proper level of government involvement in health care. But whether you favor single payer or consumer-driven health care, incentives for healthy lifestyle choices are a proven way for governments to rein in health costs.