Relationship Between Modifiable Health Risks and Short-term Health Care Charges

Nicolaas P. Pronk, PhD; Michael J. Goodman, PhD; Patrick J. O'Connor, MD, MPH; Brian C. Martinson, PhD

Context  If physical inactivity, obesity, and smoking status prove to contribute significantly to increased health care charges within a short period of time, health plans and payers may wish to invest in strategies to modify these risk factors. However, few data are available to guide such resource allocation decisions.

Objective  To examine the relationship of modifiable health risks to subsequent health care charges after controlling for age, race, sex, and chronic conditions.

Design, Setting, and Participants  Cohort study of a stratified random sample of 5689 adults (75.5% of total sample of 7535) aged 40 years or older who were enrolled in a Minnesota health plan and completed a 60-item questionnaire.

Main Outcome Measure  Resource use as measured by billed health care charges from July 1, 1995, to December 31, 1996, compared by health risk (physical activity, body mass index [BMI], and smoking status).

Results  The mean annual per patient charge in the total study population was $3570 (median, $600), and 15% of patients had no charges during the study period. After adjustment for age, race, sex, and chronic disease status, physical activity (4.7% lower health care charges per active day per week), BMI (1.9% higher charges per BMI unit), current smoking status (18% higher charges), and history of tobacco use (25.8% higher charges) were prospectively related to health care charges over 18 months. Never-smokers with a BMI of 25 kg/m² and who participated in physical activity 3 days per week had mean annual health care charges that were approximately 49% lower than physically inactive smokers with a BMI of 27.5 kg/m².

Conclusions  Our data suggest that adverse health risks translate into significantly higher health care charges within 18 months. Health plans or payers seeking to minimize health care charges may wish to consider strategic investments in interventions that effectively modify adverse health risks.

JAMA. 1999;282:2235-2239

Funding/Support: This study was supported by a contract from HealthPartners to HealthPartners Research Foundation.

Acknowledgement: We wish to acknowledge the support of George Isham, MD, George Halvorsen, and Ted Wise in the conceptualization of this study, and the advice of Agnes Tan, PhD, Michael Maciosek, PhD, and Raymond Boyle, PhD, in the analysis of these data.

Original material mirrored from The Journal of the American Medical Association: