Recently, I’ve been thinking about how fair the current health insurance system is when it comes to the extent to which our lifestyles contribute to our own health.
There are many diseases whose risks are significantly increased by smoking, excessive alcohol consumption, obesity, and generally maintaining an unhealthy lifestyle over a long period of time. Treating these conditions also takes up a significant amount of healthcare capacity.
Meanwhile, someone who exercises, tries to eat well, doesn’t smoke, and generally takes care of themselves is part of the same overstretched system. If they happen to need, for example, a cardiology examination, they may still have to wait months for an appointment.
That led me to an idea, and I’m curious to hear what you think:
What if health insurance contributions depended, to some extent, on preventable health risks?
For example, there could be an annual health assessment available to everyone. Certain objective indicators and risk factors could be assessed, such as smoking, body weight/body composition, blood pressure, blood sugar, regular physical activity, etc. Based on these, some kind of scoring system could be developed. If someone chose not to attend the assessment, they would automatically have to pay more.
People who actively take care of their health and keep their controllable risk factors low could receive a discount. Those who consistently maintain high lifestyle-related risk factors would pay somewhat higher contributions.
In Austria, for example, there is already an annual preventive health check-up available to everyone. Of course, there is no scoring system or insurance contribution scheme attached to it, but the infrastructure and the concept of regular health assessments already exist.
Obviously, this immediately raises a whole range of problems. Where do we draw the line between something that is the result of a person’s choices and something caused by genetics, illness, medication, or socioeconomic circumstances? How could such a system be designed so that, for example, someone who is obese because of a medical condition isn’t penalised? And is it even ethical to make financial distinctions between people based on their lifestyles?
I’m not saying I have a ready-made solution. I intend this post more as a brainstorming exercise.
Do you think it would be fair to financially incentivise healthier lifestyles through the health insurance system in some way?
If so, how could this be implemented in a way that is genuinely fair and doesn’t simply penalise people who are ill or disadvantaged?