June 27, 2005
By Christopher Snowbeck, Pittsburgh Post-Gazette
A new report argues that the ever-expanding waistline of average Americans is one of several factors that have led people to seek more health care and thereby balloon costs.
For a whole host of ailments, overall costs have increased because more people are undergoing treatment for their conditions, according to a study being published today in the journal Health Affairs. Increases in the cost of the treatments themselves have played a lesser role.
Obesity is a case in point.
Between 1987 and 2002, the share of the population that was overweight increased by approximately five percentage points, while the share of the population that was obese almost doubled. Since obesity is a risk factor for many ailments, it's not surprising that obese people as a group were using much more health care than normal-weight people by 2002, said Ken Thorpe, an Emory University professor who conducted the research.
In 1987, obese adults with private health insurance spent $272 more per person per year than normal-weight adults. By 2002, that difference had increased to $1,244 per person, per year according to the study, which looked at national data on health expenses for people with private insurance ages 18 to 64. Spending on medical care related to obesity accounted for 11.6 percent of all private health care spending in 2002, compared with 2 percent in 1987.
The findings argue for an approach to cost containment that boosts public health rather than scrutinizing particular expenditures, said Thorpe.
"The dominant reason why the cost of health insurance is going up is because there's been an explosion in the use of health care services, but not necessarily discretionary use," he said. "Most of the debate about how to control health care spending is: Let's change co-pays and coinsurance so that someone with flu-like symptoms might not go to the doctor.
"But that's not the real story of why spending is going up," he said.
Between 1987 and 2002, inflation-adjusted per capita private health insurance spending increased nearly 60 percent, or 3.1 percent per year, according to the study. Much of the increase was linked to expenditures on 20 prevalent health conditions ranging from diabetes to back problems.
For 16 of the conditions, the rise in treated disease prevalence -- rather than a rise in the cost per treated case -- accounted for more than half of the growth in health care spending. This was particularly true for several conditions linked to obesity.
The number of people treated for diabetes, for example, increased 64 percent between 1987 and 2002. When looking at the overall cost of diabetes, nearly 80 percent of the increase was driven by the rise in people receiving care.
Obesity isn't the only explanation for the increase in treated disease. Doctors today are prescribing drugs or other treatments for milder symptoms for many chronic diseases than in the past, increasing the number of patients being managed, the study found, while the availability of new, costly treatment options have increased treatment costs.
Increased awareness of depression among both patients and clinicians has led to a rise in treatment of the disease, even though total disease prevalence has been constant. New drugs that treat high blood pressure and cholesterol have led to substantial increases in the number of people treated. Stress, allergens and air pollution could also play roles.
What's more, some costs wouldn't necessarily be eliminated by lowering obesity, Thorpe said, since excess weight is often associated with ailments, even if it doesn't necessarily cause them.
Even so, he argued for a public health strategies that reduce risk factors. Preventing obesity in children, for example, could be the best way to tame future health care costs.
"The place to start is schools," he said. "You have to work on physical education classes, which are gone largely, on the portioning of food that kids receive and the food that goes into schools."
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