[omegadeep10]

I work at at a large health insurance company, though not involved in decision-making around annual exams or rate-setting so take that as you will.

A lot the decision-making we do is around trying to improve the health outcomes for large populations of members at scale. When dealing with millions of members, interventions that require lots of effort and time are hard to scale up. If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.

There are other benefits to annual checkups as well - catching an expensive condition early can be the difference between a $100,000 episode of care vs. a $10,000 episode of care.

To be honest internally I've noticed the tide is shifting on annual checkups. Physician time is limited and every slot is valuable. I believe we're currently exploring virtual care options as a better alternative.

[mumblemumble]

> If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.

That or it's yet another example of selection bias. There have been so so many things like this where the epidemiological data shows a correlation with health, but there isn't actually a causal link. For example, annual checkups might correlate with better health because it's a more common behavior among people who can afford to do it, and wealthier people tend to be healthier.

[e12e]

Here's a local study that try to provide some data - although I'm a little uncertain about the control with respect to yearly checkup (would you do yearly checkup on the control, then do nothing if you found cancer?).

https://uit.no/research/tromsostudy

[denton-scratch]

> exploring virtual care options as a better alternative

s/better/cheaper/

[throwaway29812]

Your industry exists only by taking in more in premiums than you give out in care, correct?

[Waterluvian]

Maybe I’m saying the most obvious thing ever, but with that last paragraph, you really make it sound like the American healthcare regimen is decided upon by the for-profit insurance companies.

[lotsofpulp]

On the contrary, preventative services such as annual checkups are mandated to be covered 100% by the Affordable Care Act:

https://www.hhs.gov/healthcare/about-the-aca/preventive-care...

[Waterluvian]

Thanks for the link! That’s quite refreshing to hear. I didn’t realize the Affordable Care Act did so much more than ensuring availability of coverage and whatnot.

[rhaway84773]

The ACA got a lot of headlines for a lot of BS but some of the really great things it did were very basic, under the radar items.

For example, a lot of the research that we are reading (including possibly the article we’re responding to) is the result of funding created by the ACA.

My favorite aspect of it is the massive push to digitization which means handwritten prescriptions have pretty much been eliminated removing an entire class of death and disease causing errors (from pharmacists misreading doctors’s handwriting).

[tehjoker]

While there are some regulations, it's basically a tug of war between business interests (insurance, hospitals, pharma, device manufacturers, testing companies, revolving door government agencies) that buy politicians and scam the government* and patients. No one would plan a health system this way, but planned economies (for the interests of regular people, not private equity) are "socialism" so we get to be the victims of life-or-death extortion rackets.

Anyway, our government continues to denounce as "authoritarian and oppressive" the tiny socialist island nation of Cuba that built an incredibly impressive health system that exports doctors (such as to Italy at the start of the ongoing pandemic) when they can't even get metal for syringes b/c of U.S. sanctions.

* For a striking example, Rick Scott was Gov. of Florida, now Senator. He was able to do this because he was rich. He got rich by scamming the hell out of Medicare. https://www.newsweek.com/rick-scotts-connection-massive-medi...

[lotsofpulp]

> If the data shows members with annual checkups have better health outcomes on average than members without annual checkups, that is something that's relatively cheap and easy to do with potentially significant impact.

In the case of annual checkups, I believe insurance companies are required to cover them 100% by the Affordable Care Act:

https://www.hhs.gov/healthcare/about-the-aca/preventive-care...

[nradov]

The ACA doesn't require insurers to cover annual check ups at 100%. Only certain preventative measures are covered that way.

[billy_bitchtits]

An annual checkup is one of the certain preventive measures and the Aca does require it to be covered with no cost sharing.

[brewdad]

But the second you mention some new issue that’s cropped up, it no longer coded as an annual checkup and you will be paying.

The only way to guarantee a free annual checkup is to go in, say nothing about your state of health, let the dr take your vitals and leave.

[ketzo]

Is this universal?

In previous annual checkups with my primary care doctor, I have mentioned symptoms as varied as:

- recent depression

- trouble breathing

- irregular heartbeat

several of which resulted in follow-up appointments / lab work, but all of which were still covered 100% as annual checkups.

[hattmall]

Do you have an ACA plan or employer provided insurance??

If you can find a doctor that takes your ACA plan then anything other than checking for a pulse is likely to result in some sort of bill.

[refurb]

Of course, billing is by procedure done.

If you bring up a complaint, it's no longer a preventative check-up, it's addressing a complaint, which has a different billing code and different reimbursement.

[nradov]

Nope. The ACA doesn't classify annual checkups as preventative measures for adults.

https://www.healthcare.gov/preventive-care-adults/

[lotsofpulp]

I thought #4/5/15 effectively make it an annual check up.