Kaelin M A, Barr J K, Golaszewski T, Warshaw L J
Department of Health Professions, Montclair State College, New Jersey.
Am J Health Promot. 1992 Nov-Dec;7(2):118-28. doi: 10.4278/0890-1171-7.2.118.
PURPOSE OF THE REVIEW. The purpose of this review is to assist those who work in the field of health promotion when considering the implementation of an individually risk-rated health insurance plan. It does so by introducing the reader to the concept of individually risk-rating health insurance; uncritically reviewing selected risk-rated health insurance plans; and exploring several issues related to plan implementation, administration, and appropriateness. SEARCH METHODS USED. The review is based on the authors' awareness of the literature in the fields of preventive medicine, health promotion, and employee benefits. The six individually risk-rated health insurance programs that are reviewed were chosen because they demonstrate how aspects of the National Association of Insurance Commissioners' Model have been implemented using various combinations of administrative procedures, verification strategies, and types of economic incentives or disincentives. This review is not intended to be a comprehensive review of the literature. SUMMARY OF IMPORTANT FINDINGS. Individually risk-rated health insurance programs have been established using a variety of administrative procedures, verification strategies, and types of economic incentives or disincentives. The frequency with which these programs are being established is increasing. As the number of risk-rated programs grows, it will be increasingly important to address the many issues that implementing such plans generate: How should lifestyle behaviors be verified? Will healthy lifestyles save money? Can employees fully control their risk factors? Is risk-rating socially responsible? MAJOR CONCLUSIONS. As risk-rating becomes more widespread, there will be a continuing need to address the business, medical, ethical, and legal issues these programs create and to refine them accordingly. The health promotion community has both an opportunity and obligation to see to it that individually risk-rated health insurance programs are implemented in a socially acceptable manner and that the outcomes they generate are cost-beneficial.
综述目的。本综述旨在帮助从事健康促进领域工作的人员在考虑实施个人风险评级健康保险计划时提供参考。通过向读者介绍个人风险评级健康保险的概念；不加批判地审视选定的风险评级健康保险计划；并探讨与计划实施、管理及适宜性相关的若干问题来实现这一目的。所用检索方法。本综述基于作者对预防医学、健康促进和员工福利领域文献的了解。所综述的六个个人风险评级健康保险项目被选中，是因为它们展示了保险监督官协会模型的各个方面是如何通过行政程序、核查策略以及经济激励或抑制措施的各种组合来实施的。本综述并非旨在对文献进行全面回顾。重要研究结果总结。个人风险评级健康保险项目已通过多种行政程序、核查策略以及经济激励或抑制措施得以确立。这些项目确立的频率正在增加。随着风险评级项目数量的增多，处理实施此类计划所产生的诸多问题将变得愈发重要：生活方式行为应如何核查？健康的生活方式能省钱吗？员工能完全控制其风险因素吗？风险评级是否具有社会责任感？主要结论。随着风险评级变得更为普遍，持续应对这些项目所产生的商业、医学、伦理和法律问题并相应地加以完善将很有必要。健康促进界既有机会也有义务确保个人风险评级健康保险项目以社会可接受的方式实施，且其产生的结果具有成本效益。
