MD, PhD, FMedSci, FSB, FRCP, FRCPEd

If my health insurance pays for this treatment, it must be scientifically tested and proven. The ‘appeal to authority’ is powerful indeed, and I imagine that many consumers fall for this argument. But it is a fallacy! Health insurances are misinforming us for commercial benefit.

In 2007, I published an analysis of German health insurance companies’ policies regarding bogus treatments (MMW 2006, 149: 55-56 [the paper is in German and unfortunately not Medline-listed]). For this purpose, I had selected three popular alternative modalities: Bach flower remedies, Schuessler salts, and kinesiology all of which are, of course, not supported by sound evidence nor by biological plausibility. What emerged from this evaluation was shocking: of the 13 companies analysed, 9 paid for Bach flower remedies, 7 for kinesiology and 9 for Schuessler salts.

If you now think ‘ah yes, those Germans are obsessed with alternative medicine’, think again. The situation in most other countries is not much better; health insurances go for alternative medicine as though there is no tomorrow. A review from the US concluded that the number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest. Because the long-term trajectory of CAM cost under third-party payment is unknown, utilization of these services should be followed. And apparently this is by no means confined to human health; recently someone tweeted that he had a very hard time finding a pet-insurance which did not offer to cover woo.

A few years after the above-mentioned publication, I was invited to speak at an international meeting of health insurers. I told the delegates in no uncertain terms that most of what they were offering to their clients in terms of alternative medicine was either unproven or disproven. There was stunned silence during the official discussion period, and I asked myself whether I had impolitely embarrassed my hosts. Then came the tea break, and one high-level representative of an insurance company after the other came to me to chat. Essentially, they all said: “We are well aware of the facts and the evidence you reviewed in your lecture; most of these treatments are useless, of course. But we have to offer them to our customers because we need to be competitive.”

In other words, health insurers, who normally are keen to keep their costs down, do not mind to pay for treatments which they know are ineffective simply because they use it as some sort of an advertising gimmick. In doing so they say or imply that these treatments do work. I think this is not just wrong and short-sighted, it is unethical and it significantly contributes to the ‘sea of misinformation’.

6 Responses to Drowning in a sea of misinformation. Part 13: Private health insurances

  • “We are well aware of the facts and the evidence you reviewed in your lecture; most of these treatments are useless, of course. But we have to offer them to our customers because we need to be competitive.”

    If that were all that was going on, Transcendental Meditation instruction would be at least partially reimbursed by most major carriers and that is NOT the case.

    • @Lawson English

      Here in the US it depends on your state of residence and which woos your State legislature has forced insurance companies to cover–almost all cover chiropractic, including Medicaid and Medicare.

      This in turn is affected by who lobbies the loudest to the legislators. TM just hasn’t organized a strong enough lobby aimed at a sympathetic Senator. Some of this takes place at the Federal level as well, such as the bit grafted onto Obamacare that says any licensed practitioner must be covered or the DSHEA nonsense that neuters the FDA’s ability to evaluate most SCAM claims–both pushed by the same US Senator (Harkin).

      The comments shared with Dr. Ernst would be heard from many major medical centers here, more so than from insurance companies I think.

      • Interesting, Tom Harkin is the US Senator for Iowa, where the TM university is based. He gave teh commencement speech there this year. So perhaps, this is his stealth way of helping the TM faction in his state, which is surprisingly strong politically given that the largest TM community in the world has only 2500 members total out of 11,000 (Fairfield, Iowa). I guess because of all the Hollywood celebrities who visit regularly, it’s politically expedient to cater to them.

  • Reading through your articles, it is becoming clear to me that the problem of “sea of misinformation” is larger than I imagined with such a diverse array of supporters.

  • Absolutely. Our BKK (German non-profit health insurance organisation) (GilSei) had a display in the canteen and boasted about providing homeopathy. I complained loudly to the man running the stand. He said he agreed with me privately, but people want it these days.

    We need a lot more education about this.

  • This is news to me. Quite horrifying really, to think that looking at ‘alternatives therapies’ cover for themselves AND their animals is important for a lot of people.

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