Carrots, Sticks, and Health Care Reform—Problems with Wellness Incentives

"Wellness programs" are offered by insurers to improve the health of a company's workers, as well as their productivity. These programs include participation incentives, which give a premium discount or other reimbursement simply for being part of a health promotion program, and attainment incentives, which provide reimbursements only for meeting targets—for example, a specific body mass index or cholesterol level. The health care reform bill will expand the scope of such programs and allow for greater levels of financial reimbursement. However, researchers writing in the New England Journal of Medicine find that the programs contain inherent inequities that could hurt patients most in need of health improvements and would assign doctors to "watchdog" roles that might harm their therapeutic relationships with patients. Harald Schmidt, M.A., a 2009–10 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, coauthored this article.