Modifiable Health Behaviors and Short-Term Medical Costs among Health Plan Members

Abstract

Purpose.

Describe the relationship among modifiable health behaviors and short-term medical costs.

Design.

Prospective study linking cross-sectional survey data that assessed modifiable risk behaviors with insurance claims.

Setting.

A large health plan in Minnesota.

Subjects.

A stratified, random sample of 10,000 yielded an analytic data set for 7983 members.

Measures.

The dependent variable was per-member-per-month insurance payment plus subscriber liability. Eighteen months of medical costs were analyzed. Control variables included subscriber age, sex, type of insurance plan, days of enrollment, chronic disease status, education, and marital status. Independent variables included self-reported health behaviors of smoking, heavy drinking, nutrition, and physical activity.

Analysis.

Linear regression was performed on the natural log of the cost variable, followed by a retransformation to dollars.

Results.

Physical inactivity and smoking were significant predictors of higher medical costs. Each day a member did not exercise there was a 2.9% difference in cost. Compared with never smokers, current smokers had 16% higher costs. Former smokers who had quit more than 1 year before taking the survey had 15% higher costs than never smokers. Recent former smokers cost 32% more than never smokers and more frequently experienced smoking-related medical conditions before they quit. Alcohol consumption was nonsignificant. Nutrition also was not significant but was narrowly measured by only fruit and vegetable consumption.

Conclusion.

Physical inactivity and smoking were associated with higher short-term medical costs among health plan members.

Keywords

Employer Health Care Costs Prevention and Control Smoking Cessation Prevention Research Manuscript format: research Research purpose: modeling/relationship testing,descriptive Study design: nonexperimental Outcome measure: other financial/economic Setting: state/national Health focus: fitness/physical activity,nutrition,smoking control Strategy: behavior change Target population age: adults Target population circumstances: education

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References

Sturm

. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff (Millwood). 2002;21:245–253.

Pratt

Macera

Wang

. Higher direct medical costs associated with physical inactivity. Phys Sportsmed. 2000;28:63–70.

Miller

Zhang

Novotny

. State estimates of Medicaid expenditures attributable to cigarette smoking, fiscal year 1993. Public Health Rep. 1998;113:140–151.

Medical-care expenditures attributable to cigarette smoking—United States, 1993. MMWR. 1994;43:469–472.

Bhandari

Wagner

. Self-reported utilization of health care services: Improving measurement and accuracy. Med Care Res Rev. 2006;63:217–235.

Mertens

Weisner

Ray

. Hazardous drinkers and drug users in HMO primary care: Prevalence, medical conditions, and costs. Alcohol Clin Exp Res. 2005;29:989–998.

Hunkeler

Hung

Rice

. Alcohol consumption patterns and health care costs in an HMO. Drug Alcohol Depend. 2001;64:181–190.

Polen

Green

Freeborn

. Drinking patterns, health care utilization, and costs among HMO primary care patients. J Behav Health Serv Res. 2001;28:378–399.

Leigh

Fries

. Health habits, health care use and costs in a sample of retirees. Inquiry. 1992;29:44–54.

10.

Wang

McDonald

Champagne

Edington

. Relationship of body mass index and physical activity to health care costs among employees. J Occup Environ Med. 2004;46:428–436.

11.

Musich

Faruzzi

. Pattern of medical charges after quitting smoking among those with and without arthritis, allergies, or back pain. Am J Health Promot. 2003;18:133–142.

12.

Anderson

Whitmer

Goetzel

. The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee. Am J Health Promot. 2000;15:45–52.

13.

Pronk

Tan

O'Connor

. Obesity, fitness, willingness to communicate and health care costs. Med Sci Sports Exerc. 1999;31:1535–1543.

14.

Pronk

Goodman

O'Connor

Martinson

. Relationship between modifiable health risks and short-term health care charges. JAMA. 1999;282:2235–2239.

15.

Goetzel

Anderson

Whitmer

. The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database. J Occup Environ Med. 1998;40:843–854.

16.

Terry

Fowler

Fowles

. Are health risks related to medical care charges in the short-term? challenging traditional assumptions. Am J Health Promot. 1998;12:340–347.

17.

From the Centers for Disease Control. Health benefits of smoking cessation. JAMA. 1990;264:2493–2494.

18.

Martinson

O'Connor

Pronk

Rolnick

. Smoking cessation attempts in relation to prior health care charges: The effect of antecedent smoking-related symptoms? Am J Health Promot. 2003;18:125–132.

19.

Garrett

Alesci

Schultz

. The relationship of stage of change for smoking cessation to stage of change for fruit and vegetable consumption and physical activity in a health plan population. Am J Health Promot. 2004;19: 118–127.

20.

Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Ga: US Department of Health and Human Services, Centers for Disease Control and Prevention; 1999.

21.

Chowdhury

Balluz

Murphy

. Surveillance of certain health behaviors among states and selected local areas—United States, 2005. MMWR Surveill Summ. 2007;56:1–160.

22.

Nelson

Holtzman

Bolen

. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Soz Praventivmed. 2001;46 Suppl 1:S3–S42.

23.

Fleiss

. Statistical Methods for Rates and Proportions. London, United Kingdom: John Wiley & Sons; 1981.

24.

Peterson

Hebert

Hurley

. Accuracy and precision of two short screeners to assess change in fruit and vegetable consumption among diverse populations participating in health promotion intervention trials. J Nutr. 2008;138:218S–225S.

25.

Physical Activity and Health: A Report of the Surgeon General. Atlanta, Ga, US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.

26.

Cigarette smoking among adults—United States, 1992, and changes in the definition of current cigarette smoking. MMWR. 1994;43:342–346.

27.

Reiter

Anutto

Hunter

. Analytical modeling in complex surveys of work practices. Ind Labor Relat Rev. 2005;59:82–100.

28.

Hansen

Madow

Tepping

. An evaluation of model-dependent and probability inferences in sample surveys. J Am Stat Assoc. 1983;78: 776–793.

29.

Royall

. Comments on an evaluation of model-dependent and probability-sampling inferences in sample surveys. J Am Stat Assoc. 1983;78:794–796.

30.

Belsely

Kuh

Welsch

. Regression Diagnostics: Identifying Influential Data and Sources of Collinearity. New York, NY: John Wiley & Sons; 1980.

31.

Polissar

Diehr

. Regression analysis in health services research: The use of dummy variables. Med Care. 1982;20:959–966.

32.

Duan

. Smearing estimate: A non-parametric retransformation method. J Am Stat Assoc. 1983;78:605–610.

33.

Breusch

Pagen

. A simple test for heteroscedasticity and random coefficient variation. Econometrica. 1979;47:1287–1294.

34.

Levene

. Robust tests for equality of variances. In: Olkin

, ed. Contributions to Probability and Statistics. Palo Alto, Calif: Stanford University Press; 1960.

35.

Manning

Newhouse

Duan

. Health insurance and the demand for medical care: Evidence from a randomized experiment. Am Econ Rev. 1987;77:251–277.

36.

US Department of Labor. Bureau of Labor Statistics: Inflation Calculator. Available at: http://data.bls.gov/cgi-bin/cpicalc.pl. Accessed September 17, 2008.