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Erica Anand

wife, mother, evolving pediatric dentist ,


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Should health insurance be related to a patient's risk?

If a patient is diagnosed as pre-diabetic, but does not improve his/her lifestyle habits (i.e diet, exercise), and the condition deteriorates, should it be the responsibility of the insurance company to pay more money for medication and treatment? This also applies to dental treatment and other health-related fields. When a patient is diagnosed with periodontal disease, but oral hygiene continues to regress, why should dental insurance have to pay for more extensive treatment when the complications could have been prevented?


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    May 7 2012: I know for some people the idea of health insurance based on a patient's risk is impossible and detrimental to the overall health of a person if they cannot be treated. But, for the commenters who agreed, I think you understand it is really about giving people responsibility of their own health and since most people are motivated by money, this type of insurance would encourage those who participate in habits like smoking, etc. to re-think their choices if they were the ones who would be paying for it.
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      May 7 2012: You are right about the opportunity for risk based premiums to influence behaviour, but that's a red herring. You can't influence people out of their genetics, yet genetics are a major contribution to risk. The problem most people have with this question is that it appears unfair when you have to pay more than the next guy, as if a loaf of bread costs you more. But the health insurance for each person costs the insurance company a different, definable amount to provide. It's not the same loaf of bread. If you are truly talking about insurance, then the premium has to be risk-based. Some other thing might be good for society, but if you have that, it wouldn't be 'insurance'.

      When I bet on a horse, I don't complain that if I bet on the favourite I get less if it wins than if I bet on an outsider and that wins. That's precisely the same problem faced by the insurance companies. A chain smoker who doesn't brush his teeth costs is simply more expensive for the insurance company to cover than a non-smoking spouse of a dentist. So their premiums should reflect that difference.
    • May 9 2012: Bad eating habits are recognized by most as food addictions, which are very difficult to treat. If you consider the number of kids and teens who are overweight and may have developed medical problems as a result, then you would penalize their parents for their lack of control. Often, a single parent is involved and control is very difficult, given their schedules and resources. I agree that some benefit should accrue for people making an effort at improving their lifestyle, something on the order of discounts for taking seminars, workshops, lectures that focus on teaching ways to improve lifestyle choices.

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