Peter Joski

The impact of obesity on rising medical spending.

Obese people incur higher health care costs at a given point in time, but how rising obesity rates affect spending growth over time is unknown. We estimate obesity-attributable health care spending increases between 1987 and 2001. Increases in the proportion of and spending on obese people relative to people of normal weight account for 27 percent of the rise in inflation-adjusted per capita spending between 1987 and 2001; spending for diabetes, 38 percent; spending for hyperlipidemia, 22 percent; and spending for heart disease, 41 percent. Increases in obesity prevalence alone account for 12 percent of the growth in health spending.

The Role of Chronic Disease, Obesity, and Improved Treatment and Detection in Accounting for the Rise in Healthcare Spending Between 1987 and 2011

BackgroundTo curb rising healthcare expenditures in the USA, the factors underlying this growth must be well understood.ObjectiveWe aim to explore how chronic disease prevalence, obesity, and improved disease detection and treatment rates contributed to the growth in health spending in the USA between 1987 and 2011.MethodsWe use spending decomposition equations to estimate the portion of spending growth attributable to prevalence increases, rising treatment costs, and population growth, respectively. We use two-part models to estimate the portion of prevalence-related spending that is potentially due to obesity. We examine changing diagnosis and treatment rates to assess how much of the growth in spending might be desirable.ResultsWe find that the share of total healthcare spending associated with the treatment of chronic disease has risen dramatically from 1987–2011. In particular, we estimate that 77.6xa0% of healthcare spending growth is attributable to patients with four or more chronic conditions. We find that rising obesity levels may explain between 11.4 and 23.5 % of the increase in healthcare expenditure for several specific chronic conditions. Diagnosis and treatment rates for chronic disease are improving.ConclusionsIndividuals with multiple chronic conditions are disproportionately responsible for rising healthcare expenditure. Much of spending growth associated with rising rates of chronic disease can be linked to rising obesity rates. Though much of the growth in spending is generally considered undesirable, disease detection and treatment rates are also rising, suggesting that at least some of the recent growth in healthcare expenditure may be beneficial.

Out-Of-Pocket Prescription Costs Under A Typical Silver Plan Are Twice As High As They Are In The Average Employer Plan

The health insurance Marketplaces created under the Affordable Care Act have attracted nearly ten million enrollees, including many people who were previously insured by an employer-sponsored plan. The most popular Marketplace plan--the silver plan--has significantly higher cost sharing than does a typical employer-sponsored plan, which may cause patients to reduce the use of cost-saving services that are essential for managing chronic conditions. We estimated the impact of higher cost sharing on drug and medical spending among patients with chronic conditions. Using national data, we compared cost sharing and prescription and medical spending for patients covered by employer-sponsored plans to the spending for those in a typical silver plan in the Marketplaces. Our results show that out-of-pocket expenses for medications in a typical silver plan are twice as high as they are in the average employer-sponsored plan, resulting in fewer prescriptions filled and refilled and in higher spending on other medical services. Maintaining the use of cost-effective prescription medications might require lower cost sharing for patients with chronic conditions than is currently found in the Marketplaces.

The Effect of Obesity and Chronic Conditions on Medicare Spending, 1987–2011

BackgroundSlowing the growth in Medicare expenditure is a key policy goal. Rising chronic disease prevalence is responsible for much of this growth.ObjectiveThe first goal of this study is to estimate the percentage of Medicare spending growth that is attributable to increasing disease prevalence rates of diabetes, hyperlipidaemia, hypertension and heart disease. Second, we estimate how much of this prevalence-related spending growth is attributable to rising obesity rates.MethodsWe employ spending decomposition equations to estimate the percentage of Medicare spending growth that is attributable to rising chronic disease prevalence, and we use two-part models to estimate the portion of prevalence-related spending that is potentially due to obesity.ResultsFor our four conditions of interest, growing disease prevalence accounted for between 13.6xa0% (in heart disease) and 58.9xa0% (in hyperlipidaemia) of Medicare expenditure growth. Up to 17.0xa0% (in diabetes) of the expenditure growth due to prevalence increases may be attributable to obesity and therefore may be modifiable.ConclusionsRising obesity rates contribute to chronic disease prevalence, which, in turn, can lead to higher Medicare expenditures. To slow the growth in spending, policy makers should consider targeting obesity, using approaches such as improving pharmacotherapy coverage and providing intensive care coordination services to Medicare enrollees.

Prevalence And Spending Associated With Patients Who Have A Behavioral Health Disorder And Other Conditions

People with multiple medical conditions are a growing and increasingly costly segment of the U.S.nnnPOPULATIONnDespite the co-occurrence of physical and behavioral health comorbidities, the US health care system tends to treat these conditions separately rather than holistically. To identify opportunities for population health improvement, we examined the treated prevalence of and health care spending on behavioral health disorders, by the number of coexisting physical disorders, among noninstitutionalized adults. The vast majority (85xa0percent) of spending was attributed to treatment of the physical comorbidities. Only 15xa0percent was attributed to treatments of the behavioral disorders; of these, a primary diagnosis of depression was most common, seen in 57xa0percent of the sample. These findings suggest the potential to improve outcomes and reduce spending by applying collaborative care models more broadly. Policies should promote payment and delivery reforms that advance the integration of behavioral health and primary care.

Enhancing screening and early detection among women transitioning to Medicare from the NBCCEDP in Georgia

PurposeThe National Breast and Cervical Cancer Early Detection Program through each state’s administration serves millions of low-income and uninsured women aged 40–64. Our purpose was to assess whether cases screened through Georgia’s Breast and Cervical Cancer Program (BCCP) were diagnosed at an earlier stage of disease and whether those who used the state’s program regularly continued to obtain age-appropriate screens as they aged out of BCCP into Medicare between 2000 and 2005.MethodsWe used BCCP screening data to identify women with more than one screen and an interval of 18xa0months or less between screens as “regular” users of BCCP. Using the linked BCCP and Medicare enrollment/claims data, we tested whether women with any BCCP use (nxa0=xa03,134) or “regular” users (nxa0=xa01,590) were more likely than women not using BCCP (nxa0=xa010,086) to exhibit regular screening under Medicare. We used linked BCCP and Georgia Cancer Registry data to examine breast cancer incidence and stage at diagnosis of BCCP women compared to the Georgia population.ResultsUnder Medicare, almost 63xa0% of women with any BCCP use were re-screened versus 51xa0% of non-BCCP users. The probability of being screened within 18xa0months of Medicare enrollment was 3.5xa0% points higher for any BCCP user and 17.7 points higher for “regular” BCCP users, compared to nonusers. Among Black non-Hispanics, the difference for any BCCP user was 13.7xa0% points and for regular users, 22.4xa0% points. A larger percentage of BCCP users were diagnosed at in situ or localized disease stage than overall.ConclusionsThe majority of women aging out of the GA BCCP 2000–2005 had used the program to obtain regular mammography. Regular users of GA BCCP continued to be screened within appropriate intervals once enrolled in Medicare due perhaps to educational and support components of BCCP.

Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies

INTRODUCTIONnWe use data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2012 to 2015 to estimate the effects of the Affordable Care Acts (ACA) Medicaid expansions on insurance coverage and access to care for low-income women of reproductive age (19-44).nnnMETHODSnWe use two-way fixed effects difference-in-differences models to estimate the effects of Medicaid expansions on low-income (<100% of the Federal Poverty Level) women of reproductive age. Additional models are stratified to estimate effects based on womens parental status, pre-ACA state Medicaid eligibility levels, and the presence of a state Medicaid family planning waiver.nnnRESULTSnACA Medicaid expansions decreased uninsurance among low-income women of reproductive age by 13.2 percentage points. This decrease was driven by a decrease of 27.4 percentage points for women without dependent children, who also experienced a decrease in the likelihood of not having a personal doctor (13.3 percentage points). We find a 3.8-percentage point reduction in the likelihood of experiencing a cost barrier to care among all women, but no significant effects for other access measures or subgroups. When stratified by state policies, decreases in uninsurance were greater in states expanding from pre-ACA eligibility levels of less than 50% of Federal Poverty Level (19.4 percentage points) and in states without a Medicaid family planning waiver (17.6 percentage points).nnnCONCLUSIONSnThe ACA Medicaid expansion increased insurance coverage for low-income women of reproductive age, with the greatest effects for women without dependent children and women residing in states with relatively lower pre-ACA Medicaid eligibility levels or with no family planning waiver before the ACA.

Index of cardiometabolic health: a new method of measuring allostatic load using electronic health records

Abstract Objective: We developed a measure of allostatic load from electronic medical records (EMRs), which we named “Index of Cardiometabolic Health” (ICMH). Methods: Data were collected from participants’ EMRs and a written survey in 2005. We computed allostatic load scores using the ICMH score and two previously described approaches. Results: We included 1865 employed adults who were 25–59 years old. Although the magnitude of the association was small, all methods of were predictive of SF-12 physical component subscales (all pu2009<u20090.001). Conclusion: We found that the ICMH had similar relationships with health-related quality of life as previously reported in the literature.

Antibiotic-Resistant Infection Treatment Costs Have Doubled Since 2002, Now Exceeding

Antibiotic-resistant infections are a global health care concern. The Centers for Disease Control and Prevention estimates that 23,000 Americans with these infections die each year. Rising infection rates add to the costs of health care and compromise the quality of medical and surgical procedures provided. Little is known about the national health care costs attributable to treating the infections. Using data from the Medical Expenditure Panel Survey, we estimated the incremental health care costs of treating a resistant infection as well as the total national costs of treating such infections. To our knowledge, this is the first national estimate of the costs for treating the infections. We found that antibiotic resistance added

2 Billion Annually

1,383 to the cost of treating a patient with a bacterial infection. Using our estimate of the number of such infections in 2014, this amounts to a national cost of