prize for mammogram

Imagine if your health insurance company offered you $15 for getting a mammogram? Or the chance to enroll in a drawing to win $250?

That’s what happened to a friend from Massachusetts. She’s still puzzled, and so are we.

Most people acknowledge that preventive care is good, and that free money is good. So why are we looking a gift horse in the mouth?

Our friend thought it was odd, and called to inquire if we’d ever heard of such a thing. We have, kind of: it reminds us of the days when you got a toaster oven for opening up an account at your local savings and loan. That somehow feels unusual in the health-care context.

It’s also a bit unsettling, this letter: it says if the screening does not apply to her, she should explain on an attached form. Then she’s offered another form, for choosing which option she wants (the $15 up front, or the chance at the $250 drawing), a form she’s urged to return whether or not she plans to have a mammogram.

It’s a growing trend in health-care: encouraging participation in wellness plans or screening by using financial incentives, or encouraging insured people to choose lower-cost (or more effective) providers with those same financial incentives.

Encouraging wellness — including things like anti-smoking programs and preventive care, like colonoscopies and mammograms — seems obvious. But it can be carried to extremes: I have a friend who’s a Size 2 who was required to take part in a Weight Watchers program as part of a wellness plan.

Another friend, a doctor, has a generally positive reaction to incentive programs, but added: “If insurers push apparently healthy habits/behaviors but don’t personalize it to particular consumers it can range from the absurd (your petite friend going to Weight Watchers) to the dangerous (pushing people toward unnecessary testing.) … The insurer may not always be targeting these interventions properly, and might be incentivizing unneeded care.”

So financial incentives? Good, generally, when well-conceived. Here’s a discussion of a number of Massachusetts wellness programs that have occasioned comment, by the excellent Carey Goldberg at Commonhealth, the WBUR public radio blog in Boston; don’t miss the river of comments.

But overuse is a huge problem in our medical system. We are reminded of our friends at the American Board of Internal Medicine Foundation, and their recent “Choosing Wisely” campaign, enumerating cases of overuse of medical testing — including many MRI’s, unnecessary bone density tests and other “preventive” tests that may not prevent anything. The tests, often, are recommended by doctors; patients may not know that a test is unnecessary.

Go, read: the excellent Roni Caryn Rabin, writing in The New York Times about the campaign, points out that many tests are unnecessary, “The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients,” she writes. “By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.”

Just to be clear, we’re not saying that mammograms are unnecessary: What we are saying is that incentives, if used, should be structured well, and that a drawing for a $250 gift certificate as a result of a decision to have a mammogram sounds a bit like a visit to the casino, and not to the radiologist for a medically necessary treatment.

Patients are consumers, and it’s hard to be an informed consumer in a system where so many incentives are misaligned.


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Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...