To avoid patients with severe conditions, the simplest strategy may be to avoid doctors who excel in treating those conditions. Patients with chronic heart disease, for example, might think twice about joining a health plan if it doesn't offer access to leading cardiologists in their area. Similarly, if health plans choose the most affluent locales when building clinics or recruiting doctors, they can reduce their exposure to poor populations with disproportionately high medical needs. Offering certain relatively inexpensive benefits can pay large dividends. For example, health club memberships appeal to the fitness-conscious.
Dental benefits attract young families.
Whether health plans have ulterior motives for doing these things doesn't really matter, said Harold S. Luft, a health economist at the University of California at San Francisco. It's the effect that counts. Aetna U.S. Healthcare underscored the threat this month when it scaled back its unusually generous coverage of high-tech fertility treatments. People with fertility problems were flocking to Aetna for in vitro fertilization procedures. It doesn't necessarily pay for a health plan to gain a reputation for inferior care.