German Health Insurers Tempt Customers with Incentives

"Eat right, exercise, get plenty of sleep." It is a motto any health-conscious person tries to abide by.

Then the list continues: "Get regular health check-ups. Don't smoke. Don't drink alcohol in excess. Cut down on stress. Meditate. Do yoga. Eat your peas and carrots." It's enough to make any well-intentioned individual feel sick with guilt. Haven't taken your vitamin today? Haven't gone jogging? Haven't flossed between your teeth? You may just land in Hell.

That's the feeling many modern individuals may get, anyway. The lists of health do's and don'ts scream out from virtually every media. Cancer lurks around every corner, obesity or back problems from enslavement to one's desk, worrying about stress causes even more stress.

Yet many otherwise sane people who know that exercise is important, for example, still find it tough have a hard time getting up from the couch and getting onto the treadmill.

Sometimes, the only way to motivate people to take care of themselves is to make them a deal. Or better: offer them something for free.

Exercising for cash and prizes

Some of Germany's health insurers have latched onto the idea. They offer what are called "bonus" or "point" programs to their insured. Once registered, participants collect "points" by getting a booklet stamped at their physician's office for regular check-ups, vaccines for children, or dental exams, for example.

The participating insured can then cash in their points for health gear or equipment, such as juice makers, MP3 players (to listen to while exercising, of course), weight scales, stopwatches or sports clothing. Some insurers even offer cash back: 60 euros ($76), say, for enough points collected. It resembles collecting miles when you fly.

Cornelia Schaefer (unrelated to this author) is a mother of three and has participated in her public health care provider's "bonus" program for two years. "Since then, I've collected enough points to get everything from bicycles to electric toothbrushes for my kids," she said. "It's a great program."

Participants can also rack up points for joining a fitness studio, taking yoga classes with certified teachers, or participating in programs to stop smoking. In addition to the "collecting points" incentives, some German insurers pay up to 80 percent of costs for hatha yoga or tai chi courses once a year for their insured.

Freebies are fun

Why the freebies? Shouldn't trying to prevent disease and remaining healthy be enough incentive to take such classes?

"All I know is that I probably wouldn't have taken a relaxation class if I wasn't collecting points for it," Cornelia Schaefer said. "With a five-year-old and three-year-old twins, I don't have much time. With the point-program, though, I'm getting something for it -- for my kids," she said.

Ralf Günther of the Allgemeine Ortskrankenkasse (AOK) -- a health insurance provider in Germany's compulsory health care scheme -- said: "We've offered prevention classes for a long time, but people expect a certain gesture from their insurer, a pat on the back for trying to stay healthy," he said.

Yet not all bonus programs are the same. Some of them require their insured to chose a model that may be cheaper if they remain healthy, but could end up being more expensive should they become sick.

Prevention could add up

Yet it is not only good will that is motivating health insurance providers to offer bonus programs.

While the German coalition government is currently haggling over yet more reforms to its costly health care system, the country faces a serious problem with its ageing population.

The elderly also translate into rising costs for insurance providers, so prevention and health incentives may help to cut costs in the long run, the insurers reason. The longer people can stay fit, the better, they say. Early disease detection through check-ups could prevent more costly treatments down the line.

Another reason for the bonus programs: health care reforms in 2004 have mandated that state-run health insurers must reinvest money saved through cost-cutting measures into programs for their insured. Many do this by helping to pay for health classes, through the "point collection" system, or by offering nutrition courses, for example.

"That's the least the health insurance companies can do," said Wolfgang Franck, who participates in his health insurer's point-collection program. "Over the past few years, people here in Germany have had to pay for doctor's visits and spend more and more for medical prescriptions. It's good to get something back," he said.

Investment returns

Free bicycles? Juice makers? Cash back? Sounds too good to be true. How to pay for it all?

Michaela Speldrech of the public health plan Techniker Krankenkasse (TK), however, said that TK's recent announcement that it would raise premiums was not due to the costs of bonus programs, but due to rising costs for hospital stays, treatments and medical prescriptions that insurers have to pay. Also, according to the compulsory health care system, "stronger" insurance companies pay into a fund to help out "weaker" ones.

The other question is whether bonus programs will ultimately pay out in euros and cents. Since the bonus programs are just a few years old, analysts can only now begin to calculate costs and benefits.

But one sign of such programs' success is the number of people participating, said public health insurance provider Barmer's spokesman Jochen Wollmert: "Of the 7.5 million people we insure, over half a million participate in the bonus points program," he said. "70 percent of those participants are women," he added.

At Techniker, 12 percent of its insured participate in the bonus point system. "We think it's important to reward people for living healthy lives rather than punish, say, smokers," Speldrech said.

Still, motivation to participate in such programs often have less to do with health, and more to do with the hunt. Günther of AOK said that collecting points is just plain fun for participants. "There is no risk involved, and people just love the idea that they're getting a good deal," he said.

The next step, many health insurancer say, is raising health awareness among less informed individuals. Those who currently take part in the programs for healthy living basically already know better; it's like preaching to the converted.

Some insurance providers are now working with schools to introduce nutrition and exercise awareness to pupils as a form of disease prevention.