HMOs as a source of infrastructure improvements?
 

What do you all think about the admittedly somewhat crazy idea of having various HMOs fund cycling infrastructures in whole or in part? As strange as this sounds, it might actually make sense for the HMOs since increased cycling leads to decreased obesity and illness, and therefore equals less cost for the HMO. IMO it would be interesting to crunch the numbers (IIRC I saw an article yesterday about the staggering cost in dollars of obesity on the health-care system) to see whether it would make sense or not.

I see a better chance of the HMO's disqualifying anything related to obesity unless it can be proven that the obesity is due to a medical problem. Of course the medical problem has to not be a pre-existing condition to be covered :)

If the HMO's were to fund it they would have to pass it on to all their customers much like the government does with taxes. I'd rather HMOs push doctors to do preventative medicine rather then push pills to treat symptoms.

Whoo boy... talk about health care funding problems... No thanks... I'd rather the HMOs work on reducing the cost of aspirin to the patients.

Let the nation fund cycling infrastructure like they did motoring infrastructure. In 1956 there was the Federal Highway act. http://en.wikipedia.org/wiki/Federal...ay_Act_of_1956

How about now that we realize that oil is providing funding for terrorists, (19 of the 20 9/11 terrorists were from Saudi Arabia, the second largest supplier of oil to the US) we need the 2009 Federal Transportation Act to fund mass transit and cycling infrastructure, to allow us to be weaned off of foreign oil.

Fund cycling infrastructure as both an anti terrorist act and to improve the health of the nation... sounds like damn fine reasons to me.

How about you?

The first number crunching exercise you might try is validating that "increased cycling" in the population actually does lead to decreased obesity and illness in the population. Ya know, real numbers and real people and real decreases in obesity/illness as a result of "increased cycling." BTW how much "increased cycling" is required before the staggering cost of obesity is affected?

As a doctor, I deal with HMOs on a daily basis. I can guarantee you they will not do anything like the OP is proposing, unless it makes them gobs of money, which it won't.

HMOs aren't interested in your health. They are only interested in their shareholders wallets.

In my office, HMOs are generally referred to as "Spawn of the Bowels of Satan."

I don't know about general infrastructure, but Group Health is a large HMO in Washington State that actively supports bicycling and at least partially funds cycling programs including the annual Seattle to Portland (STP) tour and the Velodrome series in Marymoor Park.

Naturally, there's also advertising tie ins...

FWIW, your average HMO is a business. Like all businesses, the ultimate purpose of a business is to make money. To make money, you maximize the difference between the money you take in (premiums) and the money you pay out (claims). Of course, you have competitors who are always trying to produce a better product for less, which keeps you on your toes.

Now, therefore, HMOs have a vested interest in minimizing the dollar value of the claims paid, while still keeping a steady stream of premium money coming in. If increased cycling can substantially reduce the amount in claims paid, due to people being healthier, while not leading to as substantial decreases in premiums paid, then a rational HMO would go for it. But after thinking it through some more, we might have what's known as the "free rider" problem. Since the improved infrastructure benefits everyone travelling through the area in question, regardless of HMO membership, one can argue that it's unfair for the HMO to be paying for it, when the benefits are spread out to everyone. Of course if the majority of the people in the area all are members of said HMO, then the problem is reduced.

A scheme involving matching funds (say every $1 the government commits, the HMO will match $1) might work better, in order to spread the costs. Anyway, I haven't crunched the numbers yet but will do so soon.

I don't see how it could work monetarily for an HMO. A bicycle path is pretty expensive in the millions of dollars. It is used by only a small percentage of the population. An even smaller percentage of the population would derive a measurable health benefit. So the HMO would be spending millions of dollars in order to save hundreds of dollars. That is not a good move.

However, educating the people covered by the HMO about obesity, exercise, diabetes and heart disease could well be profitable. Also having seminars and intervention programs might also be profitable. However, most corporate executives are far more interested in cost cutting than in innovative programs that might actually work. So I don't think either would get support.

Almost true, with one significant difference. Insurance companies actually make their money by taking the money they receive in premiums and investing it until they have to use it to pay claims. The HMO's income is based only partially on premiums, and primarily based on the return on their investments. Which is why you have seen premiums increase while payments to doctors decrease -- the insurance companies have not been making as much money on their investments, thus they are making up the difference by increasing the premiums. The increased premiums have nothing to do with the cost of medical care increasing.

With one exception: Pharmaceuticals. The investment portfolios of the HMOs are heavy into the drug companies, which makes sense because they are usually good investments. However, what this means is that the HMOs will prefer drug-based "cures" because that increases the demand for drugs which increases the value of their investments.

Thus, the non-drug treatments for disease, such as diet and lifestyle changes, as well as prevention measures which do not involve taking drugs, will receive little more than lip service from the HMOs, because such measures would, if implemented on a large scale, devalue the HMO's investments, thus decrease their profits.

As I said before, Spawn of the Bowels of Satan.

Yep, and you'd need preapproval to actually ride anywhere with penalties for using an out of network facility too. Return trips would need a separate approval, and you'd have to listen to that cheerful recording that says anything they tell you on the phone may not be valid when the bill is submitted "statement of benefits is not a guarantee of payment...."

The ultimate purpose of medical insurance (HMO, PPO, etc...) is to make money for the shareholders, and their performance is measured in quarterly profits. Not in the improved health of the policyholders and their 12 month policies, especially when there is a yearly renewal of their contract that allows any improvement in their current policyholders health to lower the risks of a competing insurance company if the policyholder switches companies. Chronic diseases cost the most to treat, and by doing the least they can until the policyholders get old enough to qualify for Medicare, the insurance companies focus on short term profits at the expense of the long term health of the policyholders and increased government costs to treat these chronic conditions that developed during the years the policyholder was insured by the for profit insurance companies is rewarded. Which is a long way of saying anytime there is a choice between short term profit for the insurance company and long term health of the patient, the odds favor the short term profits insurance companies.

We've found HMOs to be great political allies in getting trail projects done, just by showing their support. As large employers and a big chunk of almost any region's economy, they have a lot of political clout. They also like to have their names associated with trail projects, trail conferences, and anything to do with active lifestyles and healthy living. If private funding for a trail is called for, definitely call on them, as they're as likely to chip in as anyone, especially if another big company already has.

I think that's a brilliant idea!

Overuse of automobiles has other health costs besides obesity and illness. Most obvious are the car crashes that cost 40,000 lives a year and millions of injuries. Pollution from cars is also a major factor in asthma and other lung diseases, and may even cause cancer.

I don't think that HMOs and other insurers would (or should) directly fund bike facilities. But, like other corporations, these companies set up non-profit foundations that grant funds to health related causes. It seems that these foundations could funnel money into local or national bike facility projects.This might be a good way for them to support exercise and reduction of cars as preventive measures.

Would auto insurance companies also be interested in funding bike facilities?

What--and cut into their managers' bonuses?

If they have a major office or presence in your area then they're as likely as any other company to pay for a bike path, walking trail, park, softball field, etc.