Monday, June 27, 2005, 12:01 a.m. ET
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Private Insurance Spending On Health Problems Caused By Obesity Increased Tenfold In Fifteen Years, From $3.6 Billion To $36.5 Billion
Growing Disease Burdens from Rising Health Risks, Emphasis on Early Treatment,
and New Technologies as Key Drivers of Health Care Spending
Bethesda, MD — The obesity epidemic is adding billions of dollars to the U.S. health care tab by increasing the prevalence of treated disease: Between 1987 and 2002, the share of private health spending attributable to obesity soared more than tenfold, from $3.6 billion to $36.5 billion, according to a study published today in the online version of the journal Health Affairs. In 2002, spending on medical care related to obesity accounted for 11.6 percent of all private health care spending, compared with 2 percent in 1987.
The study traced nearly two-thirds of private health spending growth to three factors: the persistent rise in obesity and other population health risks; changing clinical thresholds for treatment that have increased the number of patients managing chronic diseases; and the availability of new, frequently costly treatment options.
Increases in treatment costs per case have not contributed much to overall spending growth —meaning that cost containment strategies, such as cost sharing with consumers, alone will not address the key factors accounting for the rise in health care spending, according to lead study author Kenneth E. Thorpe, the Robert W. Woodruff Professor and Chair of the Department of Health Policy and Management at Emory University, Atlanta.
“Current approaches to controlling health care costs are not working because they ignore the true drivers of those costs,” Thorpe said. “Increases in the number of people getting treatment for serious health problems like diabetes, heart disease, high cholesterol, and mental disorders are directly linked to population increases in obesity. If insurers and employers are serious about reining in health care spending, then obesity prevention should be at the top of their agenda.”
The study illustrates the difference in health care spending between obese people and people of normal weight. Per person health care spending for obese adults was 56 percent higher than for normal-weight adults in 2002. In 1987, obese adults with private health insurance spent $272 more per person per year on health care than did normal-weight adults. By 2002, that difference had increased to $1,244 per person per year.
During that period, the share of obese people receiving treatment for high cholesterol, mental disorders, and upper gastrointestinal disorders each increased about ten percentage points. Meanwhile, the share of obese patients treated for diabetes increased two percentage points, the study found.
Of particular significance is the link between obesity and diabetes. Thorpe and his colleagues note that between 1976 and 2000, the prevalence of obesity among U.S. adults more than doubled, from 14.5 percent to 30.4 percent. During that same period, the total prevalence of diabetes increased 53 percent.
The dramatic increases in health spending related to obesity probably stem from several factors, according to the study. First, there is greater emphasis on preventive care for overweight and obese patients than used to be the case. Second, larger numbers of increasingly obese patients may also be more severely ill and require more or more expensive treatment. Finally, a broader range of treatment options for problems related to obesity — such as new drugs for high blood pressure and cholesterol — may also be playing a role in escalating spending.
In general, the number of people receiving ongoing treatment for conditions such as cancer, lung disease, gastrointestinal disorders, and back problems has risen. In 1987, twenty medical conditions accounted for 42 percent of private insurance spending; by 2002, they accounted for 67 percent.
For sixteen of those conditions, the increase in the number of people receiving treatment — rather than rising treatment costs per patient — accounted for more than half of the growth in health care spending. This is particularly true of conditions linked with obesity. For example, treated prevalence for high cholesterol increased fivefold. Although per case treatment costs doubled, the growth in treated prevalence accounted for nearly 90 percent of the increase in spending for cholesterol problems.
In addition to obesity, other risk factors that may be contributing to upswings in disease prevalence include air pollution, ozone levels, stress, and exposure to airborne allergens. Finally, growing emphasis on early detection of chronic conditions has most likely increased the number of patients with diagnosed conditions and resulted in earlier treatment for them.
Data for the study came from the 1987 National Medical Expenditure Survey and the 2002 Medical Expenditure Panel Survey. Coauthoring the study with Thorpe are Curtis S. Florence, David H. Howard, and Peter Joski, all of Emory University.
This Web-Exclusive article is available free on the journal’s Web site, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.317. Address inquiries to Jon Gardner at 301-347-3930 or via e-mail, firstname.lastname@example.org.
To view a Kaiser Webcast
featuring an interview with Kenneth Thorpe, please click: http://www.kaisernetwork.org/healthcast/healthaffairs/28jun05.
Health Affairs, published by Project HOPE, is the leading journal of health policy. Peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of this Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will revert to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Support for the publication of this Web Exclusive was provided by the California HealthCare Foundation; Web Exclusives are also supported in part by a grant from the Commonwealth Fund.
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