Improving Health Care Cost Projections for the Medicare Population Summary of a Workshop (2010) / Chapter Skim
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4 Factors Affecting Health Status
4 Factors Affecting Health Status
Pages 47-64
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the role of chronic diseases and disability in health care costs. HEALTH AND HEALTH CARE COST CONSEqUENCES OF ObESITy Justin Trogdon (RTI International)
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Health Care Costs of Obesity How much does obesity increase health care costs at a given point in time? To answer this question, Trogdon reported on the findings from a recently published update of national estimates of annual medical spending attributable to obesity (Finkelstein et al., 2009b)
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From page 49... ...
, is applied to all of the national health expenditure accounts, assuming the institutionalized population has a similar share of medical spending going toward obesity, the Medicare costs associated with obesity could be as high as $85 billion per year in 2008 dollars. Another way to look at the cost of obesity is to ask the question: How do medical care costs associated with obesity vary over a lifetime?
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Food system changes include policies on food prices, taxes, subsidizing certain products, labeling requirements, and nutrient rules such as transfat bans. The question is: If there are structural changes in some of these underlying policies, how would that impact obesity prevalence rates?
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Social-psychological differences, differences in depression and stress, and health care access affect health. Thus, health outcomes differ by SES, and these differences affect differences in health care costs.
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looked at SES differences in metabolic syndrome and 10-year global chronic heart disease risk and found a much higher prevalence of poor scores among low SES people. In terms of risk factors, the data from HRS on the percentage of people ages 50 and older who were obese, current smokers, and heavy drinkers by education level showed that those at the highest education level had the lowest number of risk factors and those at the lowest education level had the highest number.
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SES and Healthy Life Expectancy Data from various sources show that social and economic differences in health and mortality result in more years of ill health, fewer years of healthy life, and lower life expectancy overall, for people with low SES status. These differences arise from a process of earlier onset of health problems and higher mortality.
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If the lowest group were to change to be like the highest group, there would be a substantial increase in the number of people who would need to be covered by Medicare, increasing the health care costs for the total population. In summary, Crimmins emphasized that an important national aim is to reduce health differentials.
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Both purposes, but especially the second, require that the forecasting apparatus adopt an underlying theoretical idea about the primary drivers of health care spending. In his presentation, Bhattacharya proposed the development of chronic disease and the competing risks phenomenon as the theoretical ideas driving health care expenditures.
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Combined with increasing life expectancy, these declines yield a compression of morbidity. If these trends toward declining disability among the elderly continue, then Medicare expenditures could be substantially lower than is currently expected.
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Yet the disabled elderly have higher mortality rates, which would lower lifetime Medicare expenditures. The timing of disability onset therefore has a major effect on survival as well as Medicare expenditures.
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Unlike overall chronic disease prevalence, disability prevalence among the chronically ill elderly improved substantially between 1982 and 1999. This decline more than countered the increase in disability due to increases in obesity prevalence and led to the overall decline in disability observed in the elderly population.
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Bhattacharya concluded that disability is a major driver of health care costs, but eliminating it is not necessarily a major way to improve future health care expenditures for the Medicare population. Also, primary disease prevention is not a major cost saver in future health care expenditure projections.
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Bhattacharya commented that issues relating to work are important, especially in the context of disability and changes in disability trends in the younger population because disability has effects both on health care expenditures and on financing. So if a larger share of the younger population is disabled and therefore less able to work and retires earlier, the financing models are going to be off in addition to the expenditure models.
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Data for Improved Health Care Cost Estimates Dana Goldman (University of Southern California) observed that the work of Crimmins and other research suggest that early determinants matter for future morbidity and mortality.
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. Cai and his colleagues looked at obesity status at around age 45, using the first NHANES followup survey linked to Medicare and the NDI, and obtained their lifetime Medicare expenditures.
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Todd Caldis (Centers for Medicare & Medicaid Services Office of the Actuary) pointed out that the long-term models of both the Office of the Actuary and the Congressional Budget Office already include crude adjustments for the level of population health risks.
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