On the Third Hand: The Questionnaire

I also have a general-purpose health questionnaire in an e-mail link somewhere.

When I write about the surveys, I generally think, “Oh, great. Surveys.”

When I actually got the surveys, my reaction changed to, “Why are these people who aren’t paying for any of my health care, other than, maybe, a checkup, prying into my affairs?”

Also: if the Patient Protection and Affordable Care Act of 2010 (PPACA) dies, and, even after 2014, health insurers in most states can still use medical underwriting, how can health insurers asking questions about matters that a patient has never cared enough about to bother mentioning to a doctor, then possibly use that low-level health information to deny applications for coverage, or increase the cost of coverage.

On the third hand: I give Google, Yahoo and many Web ad tracking services far more personal data every day than I will ever give to me health insurer.

On the fourth hand: clean sheeting (pretending someone who has risks has no risks) is a crime. I was scandalized a few months back when a federal agency suggested that maybe patients should have a legal right to pay out of pocket for care and ask their in-network doctor not to report the care to the patient’s health insurer.

Thoughts:

• The risk is pretty high just because every reporter and every high-octane consumer advocate will probably get one of these surveys sooner or later. This isn’t an issue that a reporter has to work to find; this is an issue that hits reporters on the head.
• The more an entity pays for me care, the more innocuous an questionnaire seems. I’m a lot more inclined to fill out a general wellness questionnaire, because at least my health plan pays for checkups, than to fill out a counseling questionnaire, because my health plan is not going to pay for that.
• A well-tailored questionnaire might seem less intrusive than an overly general or poorly targeted questionnaire.
• Maybe, to be effective and not seem oppressive, questionnaire-based wellness programs and care management programs need to run in conjunction with, at least, voluntary insurer agreements about how the answers will be used. If an insurer will increase my rates, say, 10% because I’m fat, well, maybe that makes sense. If an insurer would “reach out to help me with a questionnaire” with one hand, then use information on the questionnaire that wouldn’t normally be in my medical records to make underwriting decisions, it feels as if that would be a little over the top.
• If insurers will end up keeping the ability to use medical underwriting, and they will get to use information from wellness questionnaires in underwriting, then maybe they should at least come up with a “wellness credit rating” indicator and make sure the plan enrollees know what the rating is, to reduce the sense that the insurers have all the information and the enrollees know nothing.

I don’t really know where the right balance lies, but I think it’s somewhere between the government officially letting doctors keep important secrets from insurers and insurers running programs that, in theory, at least, could lead people to give information about themselves that could lead to huge coverage access problems later on.