Abstract
This paper describes risk rating, acknowledges reasons that have been offered to support the use of insurance-based incentives, and argues that risk rating is incompatible with the tenets of health promotion. Three major challenges are presented to those who support risk rating: 1) Is it ethical to offer financial incentives that put pressure on individuals whose illness is as linked to environmental and genetic factors as to lifestyle ?; 2) Why are some behaviors admonished while other costly activity is acceptable ?; and 3) What evidence exists that insurance cost shifting improves health or reduces health care costs? This paper concludes that incentives that increase participation in proven health ./.F3