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Cashback on medical insurance for those who exercise regularly

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Shubhankar Kulkarni
Shubhankar Kulkarni Aug 30, 2022
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You get a cashback on medical insurance if you prove that you exercise regularly. This is probably difficult with private companies but governments could establish such a system.
Why?
  1. Motivate people to exercise
  2. Governments spend a lot on medicare, especially on lifestyle-related diseases like diabetes and obesity. Most countries (governments) spend on healthcare, probably not on all citizens but on a certain class. Government spending on healthcare increased by 73% in 2021 in India due to the pandemic. Even in the pre-pandemic era, in EU countries, on average, healthcare expenditure was almost 10% of their GDPs. Several studies suggest that regular exercise reduces healthcare expenditure significantly. As an example, people with cardiovascular diseases reduced their medical expenditure by $2500, on average, in a year if they exercised consistently. Even individuals without heart disease saved around $500 a year in healthcare costs. This suggests that governments could benefit from the "Cashback system". There are other intangible benefits like reduced off days by employees, improving work efficacy.
How?
  1. People pay their medical insurance regularly (as paid previously).
  2. They wear a fitness tracker that cannot be cheated easily.
  3. They submit proof of regular physical activity (either quarterly, half-yearly, or yearly)
  4. They also submit proof that their physical activity has a positive effect on the body (maybe a fitness test , blood report, anthropometric measurements)
  5. They get a refund based on a quantifiable parameter of physical activity. The refund could be in the form of reduced future premiums, discounts on regular health check-ups, more discounts on healthcare costs, etc.
Limitations:
  1. This idea relies on finding a way to build a fitness tracker that cannot be cheated.
  2. We need a quantifiable parameter that correlates with all the parameters of fitness (cardio, muscle strength, agility, etc.) There are a few studies addressing this problem. As an example, health-related physical fitness (HRPF) is a parameter that can be calculated based on a battery of physical tests and appropriately indicates a person's fitness level on a scale of 1 to 100. HRPF has also been shown to differentiate people with comorbidities from healthy ones, validating its use.
  3. Fitness trackers usually track cardio. We need trackers for resistance training and other aspects of fitness.
Other open questions:
  1. How do we incorporate sports into this?
  2. The same amount of physical activity can affect individuals differently. What do we measure then - the efforts (time, amount, intensity of activity) or the effect (weight loss, muscle gain, other blood parameters)?

[1]https://economictimes.indiatimes.com/news/india/economic-survey-govt-spending-on-public-healthcare-rose-73-last-year/articleshow/89257199.cms

[2]https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthcare_expenditure_statistics#:~:text=Expenditure%20related%20to%20health%20system,Slovakia%20to%204.7%20%25%20in%20Italy.

[3]https://www.excellenceinfitness.com/blog/how-exercise-can-help-you-save-on-healthcare-costs

[4]Patil P, Lalwani P, Vidwans H, Kulkarni S, Bais D, Diwekar-Joshi M, Rasal M, Bhasme N, Naik M, Batwal S, Watve M. A multidimensional functional fitness score has a stronger association with type 2 diabetes than obesity parameters in cross sectional data. PLoS One. 2021 Feb 5;16(2):e0245093. doi: 10.1371/journal.pone.0245093. PMID: 33544739; PMCID: PMC7864668.

4
Creative contributions

Other ways to prove your physical activity

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Povilas S
Povilas S Aug 31, 2022
There are other ways to prove that you're exercising apart from fitness trackers. One I can think of is filming yourself while exercising. In case you regularly exercise at home, a small CCTV camera designed for this purpose could be installed at your home. You turn it on before each exercise and turn it off once you've finished. An Alexa-like virtual assistant could remind you to turn it on/off or do it for you when it senses that you're about to exercise. A dedicated video analysis software could then regularly analyze and summarize the data and send it to the responsible healthcare institution.
If you exercise in a public establishment, like a gym, yoga center, etc., then the staff member of that place could mark you as "attended this and that exercise which lasted for that amount of time" and give the data summary regularly to the responsible institution.
The problem with fitness trackers is that it might be hard to differentiate the data proving valuable or even simply intentional exercising from daily activities like walking, physical work, etc. (or should that count as well?), while the methods proposed above don't have that issue, also, you can hardly cheat that way. If you combined the proposed methods with fitness trackers you'd get the best results both data-wise and regarding cheating prevention.
However, fitness trackers are perhaps the best solution when it comes to outdoor activities like jogging, cycling, rock climbing, kayaking, etc.
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Shubhankar Kulkarni
Shubhankar Kulkarni12 days ago
Both video recording and analysis and instructor (moderator)-based moderation are good ideas. I think regular daily activities like walking should be considered as well. This is because I may choose to walk to work since I have no other time to dedicate to exercising.
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Why not measure the final effect on one's body?

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J. Nikola
J. Nikola Sep 05, 2022
Why wouldn't we focus on the final effects on one's body and track the progress of an individual?
Why?
There are many flaws in current ways of measuring physical activity:
  • devices and logs are sometimes non-trustworthy (easy to cheat)
  • cameras seem good, but can be cheated (lighter weights than what they seem, for example)
  • videos require a lot of storage (not scalable)
  • different effects of the same physical activity on people's bodies (somebody walks to work and somebody runs a lot and they have the same progress)
  • sick people not being able to get a cashback easy as others
How would it work?
  • at the beginning, people who apply for the cashback health ensurance insurance program would be asked to complete comprehensive physical examination
  • it would require blood and urine check, lung capacity, fat, muscle mass, bone mass, and other things as the standard physical examination
  • it would also include tests that define your physical capabilities such as strength, stamina, power, etc. (examples here and here); the tests are standardized and widely used
  • parameters such as age, body type, heightetc. would also be taken into account
  • after one year, a person would be asked to repeat the same tests (on the same devices, using same methods)
  • the results would be then compared to the previous ones, the general change coefficient would be calculated and a personal cashback would be given
Advantages
  • no fitness data would be required since it doesn't necessarily proves you made progress
  • standardized tests could be immediately used to prove one's performance
  • mentioned tests are harder to cheat since they would be monitored by licensed facilities
Potential problems
  • the key thing would be to create an algorithm that takes in the account the most important parameters such as age, body type, etc. and calculates the progress you made
  • the best approach would be to perform pilot tests like mentioned above over few years period and gather statistics that would be the base for the algorithm
  • people's health history should also be somehow taken into account, but I am still not sure if it would play an important role in progression coefficient calculation or not
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Shubhankar Kulkarni
Shubhankar Kulkarni12 days ago
I like the options you have provided here. The final effect on a person's body is affected by certain factors (other than exercise) that a person cannot change. For example, the basal metabolic rate is different from person to person, and you are born with it. You can change it to a certain extent but not beyond that. Similarly, thyroid secretion and signaling are vastly different across people. Such factors may affect the final results of exercise on a person's body. Going by your idea, even though two people work out together and do the same exercises, one of them (who shows better final results) will get higher cashback than the other. To avoid this, the amount of exercise performed could be recorded.
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J. Nikola
J. Nikola12 days ago
Shubhankar Kulkarni I agree with you on most of the things. That's exactly why I wrote the above contribution with an emphasis on (general change) personalized coefficients. Basal metabolism, thyroid secretion/metabolism and similar parameters would be taken into account. First, a large set of physical, chemical and physiological parameters would be experimentally checked to see how much they affect the metabolism of certain exercise-related processes (metabolism, burning calories with exercise, muscle development, etc.). The ones with the effect above a certain threshold would be selected for inclusion in the algorithm calculating the personal coefficients. That way every person would get a chance to be viewed as an individual rather than part of a group depending on e.g. body type.
The example you mentioned, about two people working out together and doing the same exercises, one of them (who shows better final results) would get higher cashback than the other, is a perfect example of how my proposition could give them both the amount of cash they deserved. Two people working out together and doing the same exercises doesn't mean they are the same. If one person trained their whole life and the other just started, they will probably not have the same results. It could be that the person who trained before needs to invest more energy to see results in their metabolism because their body is already in good shape. For that reason, the person should probably do heavier exercises. It could also be that this person needs to invest less energy due to muscle memory. In that way, earning more money would be a sort of reward for doing sports all their life.
Nevertheless, you highlighted the problem I wanted to solve - earning more cashback by performing the tasks of same difficulties for each individual, and not the same amount of them (because that way, leaner people will always be able to earn more).
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Shubhankar Kulkarni
Shubhankar Kulkarni12 days ago
J. Nikola Perfect! We are on the same page.
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Counting all beneficial physical activity instead of only intentional exercise

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Povilas S
Povilas S Sep 01, 2022
Instead of trying to differentiate between exercise and non-exercise, fitness trackers could simply monitor all your daily physical activity and see if it's enough to be counted as giving benefits to your health. Some people are way more physically active than others even without intentional exercise (e.g. walking or cycling to work every day instead of driving, having a physically demanding job, etc.).
So if a daily physical activity of a person monitored by the tracker reaches a certain healthy threshold, the data is then sent to the responsible institution, approved there and that person is allowed for the cashback. The healthier their physical activity the more benefits they get.
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proved quality of life

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Marco Agudelo
Marco Agudelo Sep 06, 2022
on why is important to be capable to prove quality of life, rather than the efforts of trying to achieve it.
Every insurance is based on possibilities, no one achieves to ensure a house that is on fire. So no public or private money should sell insurance to a healthy person for a cashback. Instead if the person is having health problems it could be a relief to do earnings in the track to recover. We are considering here health problems do to sedentary habits, obesity, depresion, are few examples, and trying to avoid more complicated misfortunes like illness derived from cell disorders.
Why
To those that this product would be an opportunity, the emitter of the insurance is telling them your illness is more expensive, please be healthy. So only effects will matters, good intentions could lead to nothing and still the insurance emitter will need to pay for the patient illness.
Work on a healthy body implies a lot of effort, on nutrition, sleep habits, mental habits, exercise, streshing, state of joy and gratitude, are a few examples and the list still be a lot longer.
In my opinion as an engineer and mathematical minder, the fact that medicine gives a lot of value to statistics, is a measure that even them do not have a clear understanding of aging with dignity. Using statistics as a cross reference of exams and health tests, is a message that if everybody is within a given pattern that would be normal and that does not fit into my comprehension of understanding things. Maybe I’m wrong.
How it works
For what I’m going to write I would appreciate it a lot if a biologist or other adequate profile could cooperate, I’m sure I can learn from further comment on this. I would search for something related to mobility. Some fundamental value of a given variable, that when higher their mobility, humans as a closed system, improves their quality of life. A variable that would never be because of a higher speed of its mobility harmful to the human system. A variable that when been higher, persons improve their elasticity, improve tolerance to eating in a diverse manner (like learning to take energy from more sources) by following the saying that those who eat of all never get ill, the skin get softer, the hair smoother, and some other characteristics of a healthy persons. What variable would be that or which group are them?
Aging is a privilege denied to the most, why not bet on it.
The process in which a person recovers from non healthy habits varies in so many ways and take a decent amount of time about four to ten years based on my experience and relations with friends and family, that in my opinion a feasible option would be to offer information to patients about know methods, personal training, self experienced advice (here the healthy ones can be hire and earn money from being healthy too) and keep track on that fabled set of variables.
By doing this the insurance may be covering the patient for a period of time until could be certified healthy or manage complex situations derived from a lack of commitment.
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Shubhankar Kulkarni
Shubhankar Kulkarni12 days ago
By this: "Instead if the person is having health problems it could be a relief to do earnings in the track to recover", do you mean that the healthy people should NOT get a cashback but a person facing certain health issues should get it?
For the "variable" that you talk about, please check this publication. The variable in the paper "HRPF (health-related physical fitness)" is very much similar to the variable you are talking about.

[1]Patil P, Lalwani P, Vidwans H, Kulkarni S, Bais D, Diwekar-Joshi M, Rasal M, Bhasme N, Naik M, Batwal S, Watve M. A multidimensional functional fitness score has a stronger association with type 2 diabetes than obesity parameters in cross sectional data. PLoS One. 2021 Feb 5;16(2):e0245093. doi: 10.1371/journal.pone.0245093. PMID: 33544739; PMCID: PMC7864668.

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Marco Agudelo
Marco Agudelo2 days ago
Shubhankar Kulkarni First congratulations on your contribution on the multidimensional functional fitness score research article . As you suggested this variable represents in good sense what I propose: “A variable that would never be because of a higher speed of its mobility harmful to the human system. A variable that when been higher, persons improve their elasticity, improve tolerance to eating in a diverse manner… and some other characteristics of a healthy persons”.
The work done in the hospital interest me in the sense that based on those physical evaluations (“examine different dimensions of physical fitness including abdominal plasticity, balance, endurance, flexibility, nerve-muscle coordination, muscle strength, core strength and agility”[ref article]) I understood, they schedule a recovery program to patients. Is of great news that the work done in the article in a search related to the probability of appearance of type 2 diabetes mellitus (T2DM) was more successful than the common belief of appearance based on obesity, body mass index (BMI) and waist to hip ratio (WHR).
There are great insights to further comment for example, on the correlations charts, male / female comparatives of each and compound measurements, classification method on quartiles, age corrected function and others, But at least to remark yet another similarity with my contribution is the comment about “We are considering here health problems due to sedentary habits, obesity, depresion, are few examples, and trying to avoid more complicated misfortunes like illness derived from cell disorders.” The article point out that “among individuals with an impairment such as osteoarthritis, anthropometric indices may have a stronger correlation with loss of functional fitness”, so this separates into groups possible disease that can be correlated with the HRPF and identifies its limitations, as I suggested should be consider.
And conclude that loss of fitness may predispose to disease(“Although this study does not ascertain the causal relationship, we did not find support to the hypothesis that diabetes progressively led to loss of fitness, keeping the possibility open that loss of fitness may predispose to diabetes.”), which may be obviously at first sight but it is not really.
I understood from the reading that the way to compute the HRPF index used on the article is done by the researchers from the article themself, and that the hospital computes in some other particular way that differs from the one of the article, the process of insight on patients information. I conclude it could be very interesting to work with the raw data, look for ways to relationate the variables. To this point I will be prudent to not suggest any change, addition of any kind or modifications on the selected variables the research center recollect for different dimensions of physical fitness, but just to indicate that the quantity of variables, mode of measure them and integration formula for the HRPF index are of extreme importance to maintain correlation with most of illness afforded for the cash back ideation we are working in this session. Very interesting to work it out.
About the other two subjects you point out in your comment -By health system, you mean the government- and -How would healthy people paying less would lead to unsustainability-,
By health systems I mean both private and public. Although I'm a participant that health systems should be public due to government obligation to provide quality of life for their citizens, in some countries the public health system is in a precarious situation and before thinking of any of these improvements we are suggesting here, it should offer good service first. So all health systems should be equally in grade to cash back users that cease to represent an expenditure.
In order to reduce period contributions to the health system by healthy patients, the business model should consider a minimum CAPEX - OPEX capable of minimizing payments to healthy users without bunking all expenses on the unhealthy community. This will result in a complex business model that requires attention of complementary institutions, rather than just decrease period contributions of a population group upon on existing health care business model.

[1]Patil P, Lalwani P, Vidwans H, Kulkarni S, Bais D, Diwekar-Joshi M, Rasal M, Bhasme N, Naik M, Batwal S, Watve M. A multidimensional functional fitness score has a stronger association with type 2 diabetes than obesity parameters in cross sectional data. PLoS One. 2021 Feb 5;16(2):e0245093. doi: 10.1371/journal.pone.0245093. PMID: 33544739; PMCID: PMC7864668. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245093

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Marco Agudelo
Marco Agudelo12 days ago
Shubhankar Kulkarni Your cited research article seems very interesting. I took a look and found it hard to read. I will check it in detail. Thank you for sharing.
About your question if healthy people shouldn’t get a cashback. Yes I mean that. At first glance may appear unfair but two things to consider. (1) I stated what kind of unhealthy habits could be considered as cashbackable (2) considering those illnesses have a potential cost to the health system, their expenses should decrease (from the point of view of a capitalism).
Since healthy people cause less risk of potential cost, healthy people instead should only pay less to the health system if one may consider it to be equitative. This should be reviewed with care because it could lead to unsustainability. What matters the most is what the health system public/private do with given resources. Right?
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General comments

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J. Nikola
J. Nikola19 days ago
I would agree with Marco Agudelo. Measuring should be avoided as a key tool for addressing a person's physical engagement. We should rather focus on the personal effects.
Fitness trackers are good for tracking your activity, motivation and social aspect of your physical engagement. On the other hand, they are not trustworthy, especially if they would be the base for a certain cashback (as Shubhankar Kulkarni mentioned). Cameras, like Povilas S proposed, would be a better solution, but still, they would require a lot of storage, and checking and are not convenient for mass usage.
On the other hand, a better way could be to measure one's progress. I wrote more details in my contribution above.
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Marco Agudelo
Marco Agudelo24 days ago
Shubhankar Kulkarni about the question what to measure I go with the effect. I will brainstorm about it and post it forward.
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