The United States is not the only country which has focused on wellness programs as a possible source of savings. Germany also encourages its citizens to maximize their health and allows incentives in its insurance plans. A new report from the Commonwealth Fund examines Germany’s experience in light of the expanded ability of US health plans to reward performance in wellness efforts. (Comm. Fund Report) Ninety percent of Germany’s citizens obtain health insurance from one of about 150 health and sickness funds, with most of the cost borne by consumers and some by employers. Individuals have an affirmative responsibility to try to stay healthy and the funds are allowed to provide relatively modest incentives, around $150 a year, in the form of cash, reduced contributions or other rewards. The incentives can only be paid if there are savings caused by the wellness program and must be paid from those savings. In the US, incentives can now be as high as 30% of the cost of coverage, which is likely well over $1500 a year and the incentives can in essence shift cost from participants to non-participants.
The report looked at data from one large sickness fund regarding wellness participation from 2004 to 2008. In that time the fund saw a net savings of about $140 a year per participant. Interestingly, among consumers who had no health care costs in the year prior to the start of the study period, those who went on to participate in the wellness efforts had higher costs than those who did not. This is likely attributable to those people uncovering untreated health issues and hopefully this subset will be tracked over time to see if in the long-term they have savings. Over time, more healthy people and middle-income people participated in the programs, which the authors claim raises social disparity issues. It seems more appropriate, however, to focus on the individual responsibility aspects of wellness and as long as everyone has an equal opportunity to participate, a person should bear all the consequences of either participating or choosing not to.