What cost can you put on preventative health care?

It is an area to which health insurance funds are paying more attention of late.

HCF, one of Australia's largest not-for-profit funds, recently launched a phone and web-based service to help members quit smoking, lose weight and manage high blood pressure and cholesterol.

The free service, the first of its kind, offers specialised help to manage chronic illnesses including diabetes, asthma and heart disease.

Some of Australia's other big health insurance funds have been trialling similar programs.

Some pair nurses with particular members to encourage them to exercise, visit the doctor, interpret their diagnoses, eat properly and maintain a healthy weight. Some even offer $100 vouchers towards aqua-aerobics.

A professor of public health at the University of Sydney, Adrian Bauman, says evidence shows phone-based counselling or coaching can work, as long as participants are motivated.

Bauman is reviewing Get Healthy, the NSW Government's public health initiative. It allows people to ring trained health professionals for up to 10 free sessions to encourage healthy weight, healthy eating and exercise.

"The Government is trialling these kinds of lower-contact interventions because they can't provide gyms, dieticians and behavioural consultants on a one-to-one basis. So they are trying it with a low-cost method such as telephone counselling," he says.

HCF says the $100 million it has spent on its disease-management service, My Health Guardian, will please its bean-counters just as much as it will its 1.1 million members.

The chief medical officer of HCF, Dr Andrew Cottrill, says the main point is improving the health of members. In turn, that will also result in reduced hospital visits, reduced claims and keep premiums lower for other members.

Cottrill says its pilot program, involving more than 3000 people, has seen up to 17 per cent reduced hospitalisation with some conditions.

The number of patients with diabetes seeking annual foot examinations rose from 58 per cent to 86 per cent and the number of patients with heart conditions who checked their weight daily has risen from 29 per cent to 73 per cent (sudden weight increases can be a sign something is wrong).

Weight loss for several members with diabetes has even reversed their diabetes, as confirmed by lab tests.

HCF says the service is not a substitute for medical care but it is designed to help members get healthy and stay healthy by filling the gaps between visits to GPs and hospitals. The program will also be particularly useful for people living in regional and rural areas, where access to health services is an issue.

The chief executive of Medibank, George Savvides, says the company has spent about $490 million buying AHM and Health Services Australia to enable it to expand its programs. That's almost doubling the number of its employees and changing the focus from being a claims-payment company to one that is more involved in its membership, Savvides says.

"Two per cent of the customers claim 45 per cent of our hospital claims. A major proportion of those have chronic diseases," he says.

Medibank says it has seen a 25 per cent reduction in hospital use by a group of 300 members in Perth who are on a preventative health program using a GP network.

Savvides predicts preventive health initiatives by health funds are going to become widespread, not just something the big funds are doing.

Smaller funds are likely to outsource to larger ones.

The chief medical officer at health provider Bupa, and chair of the National Health and Hospital Reform Commission Report released in July, Dr Christine Bennett, says it's common sense for both public and private health funds to seek ways to avoid hospitalisation.

Australia is facing what she calls an oncoming "tsunami" of chronic disease associated with an ageing population – heart problems in the ageing, diabetes and asthma, for example.

Bupa – a global fund that merged MBF and Bupa's Australian brands, MBF and Mutual Community, and covers about 3 million Australians – is also building on pilot preventive health initiatives Bennett says work.

"The health funds' interests are aligned with those of the members," she says. "If they live longer, healthier lives with minimum use of hospital system, then it's good for them and good for the membership."

Health fund program has retiree back on track

It's been ages since Graham Berthoin exercised. But now that he's on a new program with HCF, he's back on a hospital exercise schedule and about to re-start aqua-aerobics.

With emphysema and decreasing kidney function, Berthoin, who lives in retirement in Sydney, finds it hard to walk more than about 100 metres without stopping for a rest.

However, Berthoin now has a nurse who rings him every few weeks, checking how he is and offering him advice.

It was she who encouraged him to go back to his doctor and see if he was eligible for his local hospital's exercise program — one that he has attended in the past. Last time he went on the program, he says he lost a good number of kilos.

"It improved my health terrifically." But when he finished, he ended up back where he started. And he stopped exercising when left on his own.

"Lauren talked hard. She said: 'Well listen, Graham, you should be exercising. Why haven't you asked your doctor about it again?' I said: 'I don't know if I can get back in.' She prompted me to try it."

So now he's back on the treadmill and about to head back to the pool. If the weight stays on, he'll start writing down what he's eating and talk to his nurse about it. She may send him to a dietitian.

She'll also ring from time to time to check how he's doing.

Berthoin feels he can talk his health problems over with her, when family or his partner might not be so understanding. "She makes me feel comfortable."