Digital pedometers and Swiss health insurance, a match made in heaven

Swiss health insurers could demand higher premiums from customers who live sedentary lifestyles under plans to monitor people’s health through wearable digital fitness devices.

CSS, one of Switzerland’s biggest health insurers, said on Saturday it had received a “very positive” response so far to its pilot project, launched in July, which is monitoring its customers’ daily movements.

The MyStep project, developed in conjunction with the University of St Gallen and the Federal Institute of Technology (ETH) Zurich, is using digital pedometers to track the number of steps taken by 2,000 volunteers until the end of the year, synchronizing that data with an online portal on the CSS website.

But don’t worry, that is just the pilot program:

Fitness wristbands such as Fitbit are just the beginning of a revolution in healthcare, believes Ohnemus.

“Eventually we will be implanted with a nano-chip which will constantly monitor us and transmit the data to a control centre,” he said.

Obesity in Switzerland now costs the health service eight billion francs a year, according to figures from the Federal Office of Public Health, rising from 2.7 billion in 2002.

There is more here, and for the pointer I thank Axacatl Maqueda.

Comments

Except that under the current regulatory framework, there is no risk-based pricing possible allowed (aside of rough geographical segmentation, gender, and three age pools of 0-18, 18-25 and above 25).

Not to mention the entire framework of data privacy, which the Swiss seem to value quite highly.

The ACA allows a premium hike for smoking so it would be easy to add one for not exercising.

If this passes, I see a Markets In Everything entry -- machines that create movements to trick the Fitbit into thinking it's attached to a human and that that human is getting lots of exercise.

Then they'll make them illegal just like radar detectors.

You'd need to fake a pulse too. This was a problem with the Apple Watch, which assumed it was not being worn when it couldn't detect the pulse of someone who had wrist tattoos. It works okay with black people, but some tattoos will block the optical pulse sensor.

Would the device be smart enough to detect it had been clipped onto a clock pendulum, perhaps even one those fake pendulums one sometimes sees on a quartz clock?

If it's too smart for that, strap it onto the leg of a puppy.

Some of these things have GPS. They'll know if you're not going anywhere.

I'd be happy to amend the ACA to allow the insurers to discriminate on cost (within limits) on the basis of exercise and other empirically-proven behavioral health factors.

How about managing your diabetes?

I thought there was zero evidence that anyone can reduce healthcare costs because prevention never works.

Shockingly, the ACA does not apply to Switzerland...

ACA applies for NY state? https://gigaom.com/2014/12/08/insurance-provider-oscar-will-reward-you-if-you-hit-your-step-goal/

Using pedometers to track their steps. What a brilliant idea.

This way the police can track if they get too close to a school or playground.

Protect our children, protect our future.

I work with a pedologist, if you think that is funny you should come to his soil lab.

Too late, if they're in school they are already in a high risk zone. The risk of becoming indoctrinated as a political leftist.

So THAT's how they're going to convince us all that it's in our interest to all be chipped. Savings on health insurance for those who opt in.

Of course, NSA and their analogues in other countries would never, ever, ever dream of mandated access to everything about everyone at all times.

Another argument in favour of public health care if you ask me ...

What makes you think public health care wouldn't mandate the same device?

Between public and employer-paid? Public gives me a better chance of using the political system to stop crap like this. A cashier at Target has zero voice in mgt decisions.

I agree the employer-based system is problematic. If everyone had individual plans they could choose whether they wanted this or not, with a small price cut for those that choose to do it.

The other thing is that with public healthcare it's very easy to argue that lifestyle choices are now everyone else's business. Why should I have to pay extra to cover your poor lifestyle choices?

Hmmmm. Good point. I think I would be even more suspicious if it were mandated by public health than an opt-in for insurance reductions.

I am enormous suspicious of anything that motivates people to be monitored 24/7. (So the de facto ability to track people by cell phone signals is already of moderate concern, but I still use my cell phone every day.) Not to the extent that I worry of things going too crazy in MY lifetime, but that a slow erosion of values/expectations or what have you could lead to a situation where we are all monitored in all ways at all times, at some date relatively far in the future.

I find it almost impossible to imagine how political freedom could be upheld under such a hypothetical future system. I can just imagine some sick quacks in the CIA or KGB dreaming up plans where these implants could be two-directional, and where they could literally use waves to "brain-whip" people or something. It would start with some innocuous-sounding argument like "how nice would it be to press a button and incapacitate a terrorist" or something. Proceeding from there towards an absolute end of free thought...

I know it sounds crazy, so you don't even have to say it. But I honestly believe that if we aren't vigilant about these risks, that it will go that way eventually. The key is that every step of the way we will think that we demanded it. It plays well with the narrative of the "politics of fear" used for political gain and to "control the masses" sort of thinking.

In the meantime, I'm sure we'll find loads of really useful things for such technologies, so I wouldn't want to get in the way of technological advance :)

I assume you are definitely not voting Republican....

Somehow, they are all going to instantly roundup tourists, etc the instant they become illegals...

I quite often argue that I am willing to tolerate a fairly high risk of criminality to prevent the potential dark side of the police state from coming to fruition.

I'm Canadian. I vote Green (and have run for the Greens). Given how heavily hit almost every environmental charity in the country has been in recent years under our anti-science anti-green government, with many millions spent in special audits by the tax agency and additional secret services resources dedicated to monitoring environmental organizations, at present we (Greens) are probably more attuned to these risks than other political affiliations.

haha. Republicans. I like to think I'm not too ideological, but WOW, there's basically not one iota of anything that any of them stand for (not speaking ideals, but actual policy prescriptions) that doesn't get me shaking my head. I bet the first Republican candidate to endorse GPS ankle bracelets for visiting Latinos (or worse, ALL Muslims) would get a sudden surge in support.

Target is giving away free FitBit bands to its employees.

http://www.dailymail.co.uk/news/article-3236932

Hey, how come you're not moving? Get back to work!

Activity bands - the slavemaster's dream.

I think Target will do better than that, but I think it's a legitimate target of fearmongerning

So now I know how to make extra money when I go hiking: carrying my obese friends' pedometer won't add much weight on my backpack and could be quite useful to them !

Markets in Everything - fitbit edition.

This was exactly my thought when I read the story. I was also reminded of the ticketless insurance on Indian railways:

"some touts have floated an “insurance scheme” which guarantees the commuter ticketless travel for a monthly premium of about Rs. 100, guarding the commuter against any inspection by the Railway authorities or the police.

If the ticketless traveller is nabbed, sponsors of the racket pay the charges. The subscriber goes scot free without bearing any additional burden."

This. You just have to calibrate how much to charge him so it's worth the premium reduction he will get.

Of course you wouldn't need another person need to carry someone's pedometer. If people wanted to cheat, it would be easy to make a machine that mimicked the motion well enough.

The nano-chip scenario sounds unlikely. Way too significant privacy concerns, even without government involvement (somebody pulls an Ashley Madison, and good luck landing a meaningful job if you have an eighty percent chance of dying from cancer within five years), but aside from that it kind of defies the purpose of insurance.

Compulsory health? Obligatory fitness?

Do these proffered wristbands and nano-chips actually dispel rodentiary fragrance, or do they conjure the latter as reliably as this account suggests?

I wonder how good the correlation really is between sedentary lifestyle and high healthcare costs. Hypothesis: both tails are high (very active people suffer sports-related injuries), but incremental differences in the middle make less difference than people expect. I share privacy concerns, although basic pedometers use only an accelerometer. Trouble is they don't count swimming or cycling, and you can cheat easily.

From what I have seen, this is where diet and exercise data is strongest. Inactivity is very bad for the body.

Sports related injuries are trivial cost, usually no more than a few thousand dollars per incidence. Diabetes, heart and artery diseases are very expensive. And the incidences are entirely different.

http://www.webmd.com/fitness-exercise/20150119/too-much-sitting-can-be-deadly----even-if-you-exercise-review-finds

I can see the Swiss man of the near future:

"Turn on the TV please"

"I am sorry, I can't do that Dave. It is time for your walk"

Most people already wear wireless monitors for tracking their movements. And they do it voluntarily. And people will wear wireless monitors to track their heartbeat, their blood pressure, all of their vital signs. And they will do it voluntarily. And people will wear wireless monitors to track their purchases of both good and bad products including whiskey and potato chips and fast foods. And they will do it voluntarily. And people will wear wireless monitors to track their communications including their speech and their writings. And they will do it voluntarily. And some wonder why millions went to their deaths without resistance.

I seriously doubt it is most people.

184 million people in the U.S. own smart phones. I'd say that qualifies as most.

I thought you meant Fitbits.

An AMA study actually said phones were sufficient for fitness tracking. They miss some steps of course, and cannot track sleep, so I recommend a $15 Xaiomi MiBand. 30+ days between charging.

Assuming you have iPhone, Settings>Privacy>Location Services>System Services*>Frequent Locations

Mine had figured out which location was my home and which was my office, I'm assuming based on my daytime/nighttime usage patterns. Who knows what else Apple learned about me? Small steps toward a terrifying dystopian future! :)

it is interesting. Apple and Google know far more about us than anyone dreamed, but at the same time, their interest in you or me specifically is lower.

it is a statistical interest, and my "numbers" only affect the relative popularity of woodworking videos on YouTube, etc. beyond that, they don't care.

I agree, but that's true until it isn't. In the event that google (or any entity with the power to subpoena google) took an interest in that information, there it is. So anyway the real lesson is don't tell your wife about this.

Right. Since corporations have little interest in the specific us, but governments do, that is the specific privacy link to safeguard at this point. Subpoenas should be hard.

Anecdotally, however, many if not most of these 184 million Americans are idiots (id est: I have never owned or operated a smart phone or any other kind of wireless phone, and I most often spy my fellow Americans using their smart phones, etc., from behind the wheels of moving vehicles, I've even begun encountering Americans immobilized in grocery store aisles and mall commons areas consulting their "smart" phones, I've even managed to read a printed map faster and more accurately than a helpful restaurant employee was able to consult his smart phone for the inaccurate directions he was able to provide).

Ha, so you're that guy whipping out and unfolding his paper map!

Not everyone who owns a smartphone uses it to monitor their heartrate, blood pressure, and other vital signs. Or any of those other things.

I would estimate that the actual number of people who do this is under a million.

Ludicrous. Americans would never let the government get away with tracking the movements of the population.

(Oh, they already did.)

Some people already voluntarily monitor every purchase they make for social and environmental consciousness.

Is it recycled? is it biodegradable? Is it fair trade? Is it organic? Is it non-GMO? Is it made by Guatemalan peasants in a worker-owned co-op?

My employer gives out Fitbits and tracks the results. Voluntary at this point, and their are only rewards, not punishments, so far.

However, I'm overweight, and getting 10k steps a day hasn't caused me to lose weight. Activity alone can't solve obesity.

No. Diet is very important, and doing 10k walking is not enough, 10 k running, maybe. There also other positive effects on stress (at least for me, it really helps me clearing my mind...)

Well, running is overrated. Running is good for losing fat quickly and have movie star abs. However, don't confuse "quickly" with "sustainable". Very few of us will be able to run at 70 years old. That's why walking and diet is important , you can do it at any age.

That's why I also laugh when people say that football, basket or any high impact sport is a good thing for the young, education for life or similar myths. Yes, it's great fun, but if you can't practice your sport after 35-40, where's the damned long term benefit?

Well, yes, but the average person trying to lose weight is not 70. Then is a bit too late... For me the benefit of running is more on stress, because i didnt experience any weight loss!!! Same story since i joined the gym. And i am not really slow, compared to the average person running in the place where i live, i think i am quite a bit faster (5:15-5:30 per km)

I'm running, too. No weight loss.

I'm somewhat dieting too. Probably not disciplined enough... but no weight loss.

I suppose I should use the Fitbit app's food tracking capabilities... but I don't.

There's a real issue with discipline with us overweight folks. It's more than just a tracking issue.

Best success I've had is with a low-carb diet combined with moderate exercise. I used the stairs not the treadmill.
Also, I enjoy using the fitness tests on the machines. Getting to "average" or "good" on the fitness tests is a bit like winning a level in a video game.

the body is very efficient walking flats. hills are different. mountains are even better.

still, walking 10,000 steps probably is a good baseline activity, to move one off "sedentary."

No question, I've got more muscle from walking, running, and doing a little upper body exercise. My heart rate, which my Fitbit also measures, is in a decent range (resting rate about 60 bpm, fluctuates more than you would think).

But when the bureaucrats talk "Health", what do they mean? BMI. By that measure, I suck! Firmly in the overweight range, and really no change over the last couple months, despite a good deal of exercise, which my Firbit also tracks.

Like I said, tracking and just knowing your level of activity is not enough to lose weight when you are middle age.

BMI got popular because no matter what else, people knew their height and weight. Something like a treadmill stress test is much better, but hugely expensive and not justifiable for screening.

Now the interesting thing is that your Firbit with heart-rate now knows your recovery time, which is hugely important. As that stuff spreads, BMI will go out the window.

"Now the interesting thing is that your Firbit with heart-rate now knows your recovery time, which is hugely important."

Fitbit needs an API, because the functionality is really basic. It could do A LOT more than it does... in theory.

Well, before quoting your favorite B-movies, read this interview (http://content.healthaffairs.org/content/29/8/1442.full)

"Cheng (Question) Many Americans bristle at the idea of being mandated to purchase health insurance and see it as a violation of their individual freedom. The Swiss are known for jealously guarding their individual freedom, too, yet they accept their own mandate to have adequate health insurance. As one such freedom-loving Swiss individual, would you defend the Swiss mandate?

Zeltner (Answer) That’s easy. We will not let people suffer and die when they need health care. The Swiss believe that in return, individuals owe it to society to make provision ahead of time for their health care when they fall seriously ill. At that point, they may not have enough money to pay for it. So we consider the health insurance mandate to be a form of socially responsible civic conduct. In Switzerland, “individual freedom” does not mean that you should be free to live irresponsibly and freeload from others, as you would put it."

The Swiss "social contract" says the others won't let you die if you don't have enough money to pay for healthcare. However, individuals owe to others the very existence of this safety net. Right now the contribution to the health care is with money, positive money in the health insurance balance sheet. The 10K steps a day pilot program is an experiment of another way to contribute to the shared safety net. However, not with money, but with less expenses (less negative money). The incentive is that you comply with the program you pay less for health insurance complementary policies (loss of income, extended hospital stay, non-profesional accidents, etc).

So, this thing is not imposed on the Swiss by a king or big government. Public opinion is fine if an individual goes a year to jail for speeding on the highway. Black market labour is not treated with indifference by neighbors, eventually the police will show up after a neighbor's tip. If this thing becomes a federal program in Switzerland, it will be by a federal referendum, not imposition.

Individuals "owe" to others the existence of a safety net they don't agree with and have no say in?

"We won't let you go without a car so in return you have to buy car-buying insurance"?

It's also a bit strange to say that "We" will not let people suffer and die so they owe it to society to make provision ahead of time to pay for their health care. If you are paying for your own health care ahead of time then there really is no safety net?

The safety net is that the Government will pay for the insurance in case you cannot (usual means-testing approach?).

It's an end-run around freedom because some people don't trust others to make decisions, especially impoverished folks, minorities, and women.

How do the meters know who they're attached to? How long until someone is walking around town with 25 bracelets on their arm generating steps for a couple bucks each.

The same technology that puts ankle bracelets on criminals--and keeps them there.

easy. use ubiquitous surveillance, and facial recognition, to randomly audit

Switzerland is in Europe, and they have obesity issues? But that's unpossible!

Worse, Switzerland is mountainous. You can't walk anywhere without going up and down hills.

I don't know, the real problem I have with 10,000 steps is that it feels like a complete waste of time. It takes like two hours of just walking to get that many steps.

If you are in shape for it, 10 minutes running will probably do you more good.

Related - I once saw a interwebs story about running one mile, and one mile times. The story was that for middle aged men a 1-mile time was a great predictor of life expectancy. The claim was that "they" didn't want to tell anyone though, because a bunch of heart-attacks-waiting-to-happen would get out there and try. So, build up to it.

"Hard to believe, but yes, it is. Several years ago, researchers at Stanford University asked 18 middle-aged, novice exercisers to run for just 10 minutes per workout 15 times a week for eight weeks. In spite of the brevity of the workouts, the men boosted their max VO2 (the maximum amount of oxygen your muscles can use) by 8 percent, increased endurance by 12 percent, lowered heart rate by 6 percent and lost 4 pounds of body fat."

http://www.runnersworld.com/workouts/got-10-minutes

I was out on one of my crappy little runs (56 minutes walking, 9 minutes running) when I had a couple blasts from the past.

One was about a co-worker. Genius level UNIX hacker, but shaped a bit like a bowling pin. 10 years ago he wore a heart monitor for 3 days, ran around, stressed himself, and got a clean bill of health. He was proud when he told me (I guess because I was then a skinny mountain biker), and I was supportive. He died suddenly last year of cardiac arrest, leaving me to wonder now if I should have reacted differently.

Another is a brilliant lawyer, makes millions, but had a sudden "event" last year. If he hadn't been standing by his iPhone when he started feeling dizzy, and got "911" into the phone, all say he'd be dead. Sudden blood pressure drop, no evidence found, written off as "unknown infection." When he says it's unrelated to weight (250?) I am supportive.

I guess the bottom line is that if your friends are supportive ... don't always trust them.

Hmmmm. Good point. I think I would be even more suspicious if it were mandated by public health than an opt-in for insurance reductions.

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