Assessing quality in a hospital may be determined by such things as whether it performs more cesarean sections than its counterparts. The plan's benefit packages include the lists of doctors and hospitals. But most patients do not know or have access to a health plan's formulary. Most people are in a given plan slightly less than three years. Consequently, it is hard to see the return on an upfront prevention program because the patient may leave the plan before the cost savings of the investment are seen to be effective in reducing long-term costs.
Smoking is the leading risk factor for heart disease, lung cancer and osteoporosis.
If more people with these illnesses joined, the plan could end up with higher premium costs, ruining its marketplace competitiveness with plans that don't offer such programs. Another flaw is that most plans contract with physicians who have their own private practice in the community. These physicians, in turn, contract with several health plans simultaneously. This makes it virtually impossible to have access to patients' records over the long run to assess the impact of cost and quality decisions. Patients are not in plans long enough, and most plans do not have the research mechanisms in place to track patient outcomes.