If you're a frugal Swiss, you might consider skipping that second helping of chocolate fondue and taking a brisk alpine walk, or one day face higher insurance premiums.

That's because a newly-launched pilot project from one of its biggest insurers, CSS, is looking at the relationship between activity and health, which may soon lead it to set different premiums for the fit and the unfit.

The project highlights both the promise and the potential ethical and legal pitfalls that stem from new health-monitoring gear such as the FitBit, Apple Watch and other biometric equipment.
CSS's MyStep project, developed with the University of St. Gallen and the Federal Institute of Technology (ETH) Zurich, tracks the number of steps taken by 2,000 volunteers using digital pedometers. At the end of 2015, this data will be used to "reveal whether and how insurance companies can introduce an appropriate offer tailored to customers’ needs,” according to a statement by Volker Schmidt, head of technology at CSS.

The point of the pioneering project is twofold: to find out how much data the insured are willing to share and to establish if self-monitoring helps individuals lead a more active life – considered to be about 10,000 steps a day.

“So far the response has been very positive,” Schmidt told the German-language publication Blick.

If the project works out, it will also prompt an interesting question: Can someone be forced to wear health-monitoring gear as a condition for either supplementary or compulsory basic insurance? And if a person refuses such monitoring could they wind up paying a higher premium?

“Given the increased cost of health care, we will inevitably have to promote individual responsibility in order to strengthen solidarity between insured people,” he noted to the paper.

The nature of insurance, which pools risk, certainly does force the issue of personal responsibility and self-monitoring, now that technology is beginning to appear that would permit much more intrusive, albeit automated, data gathering on an individual level. The question arises of what individuals "owe" to their fellow insured.

“There’s no solidarity if someone who does a lot of sports and takes care of their health has to pay the same high premiums as someone who smokes, drinks and drives, and does not play sports,” Peter Ohnemus of Dacadoo, a company specializing in collecting health data, told Blick.

But the data-collection expert also takes the issue to an even-more-challenging level.
“Eventually we will be implanted with a nano-chip which will constantly monitor us and transmit the data to a control center,” he said.

Money will inevitably push this debate to the fore. "Health analysts estimate that around 70 percent of the annual $2.6 trillion bill for health care costs in the U.S. are the consequence of potentially changeable human behavior," noted Andrew Leonard of Backchannel.

As CSS's study shows, for the health care industry, and especially for health care insurers, health- and behavior-monitoring devices represent a technology, an ethical challenge and a cost-benefit opportunity too important to ignore.

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