Best wishes for a wonderful holiday season from Improving Population Health. We regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). For this year-end roundup, we’re highlighting a couple of recent articles and also listing those we’ve called attention to earlier in the year.
McCullough JC, Zimmerman FJ, Fielding JE, Teutsch SM. (2012). A Health Dividend for America: The Opportunity Cost of Excess Medical Expenditures. American Journal of Preventive Medicine, 43(6), 650-654.
This must-read article highlights the recent IOM estimates that $750-$765 billion spent on health care in the U.S. is in excess of what should be spent to achieve our observed health outcomes. Of this amount, the IOM estimates that $421 billion accrues to the private sector which the authors say is “functionally a tax that limits the international competitiveness of the US and reduces the economic welfare of the population.”
This paper focuses on the public sector which pays the remaining $337 billion and questions the “public opportunity costs of the unnecessary healthcare spending,” which they call a Health Dividend and characterize as “a sizeable stream of resources that would come at no net cost to people’s health and that could be invested in achieving two important objectives: stabilizing the nation’s fiscal health and improving well being.” The authors identify specific investments contributing to Fiscal Stability, Social Investments, and Infrastructure Investments that such a dividend could support. The authors conclude with a clear vision: “whatever one’s values and preferences, eliminating excess medical care costs provides a monumental opportunity to reallocate those resources to strengthen U.S. international competitiveness, enhance well-being, and build a healthier nation. The result of redirecting some $750 billion per year could be transformative for Americans, and the potential uses for these funds are panoramic in both scope and possibility.”
Goetzel RZ, Pei Xiaofei P, Tabrizi MJ, Henke RM, Kowlessar N, Nelson CF, Metz RD. (2012). Ten Modifiable Health Risk Factors Are Linked to More Than One-Fifth of Employer-Employee Health Care Spending. Health Affairs, 31, 2472-2484.
Abstract: “An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers’ modifiable health risks and increased health care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold. Based on our sample of 92,486 employees at seven organizations over an average of three years, $82,072,456, or 22.4 percent, of the $366,373,301 spent annually by the seven employers and their employees in the study was attributed to the ten risk factors studied. This amount was similar to almost a quarter of spending linked to risk factors (24.9 percent) in the 1998 study. High risk for depression remained most strongly associated with increased per capita annual medical spending (48 percent, or $2,184, higher). High blood glucose, high blood pressure, and obesity were strongly related to increased health care costs (31.8 percent, 31.6 percent, and 27.4 percent higher, respectively), as were tobacco use, physical inactivity, and high stress. These findings indicate ongoing opportunities for well-designed and properly targeted employer-sponsored health promotion programs to produce substantial savings.”
Featured Articles of 2012
Ross, Nancy A., et al. "Trajectories of health-related quality of life by socio-economic status in a nationally representative Canadian cohort." Journal of Epidemiology and Community Health 66.7 (2012): 593-598.
POPULATION HEALTH POLICY
Mechanic, Robert E., Stuart H. Altman, and John E. McDonough. "The New Era Of Payment Reform, Spending Targets, And Cost Containment In Massachusetts: Early Lessons For The Nation." Health Affairs (2012).
Stockwell, Tim, et al. "The Raising of Minimum Alcohol Prices in Saskatchewan, Canada: Impacts on Consumption and Implications for Public Health." American Journal of Public Health 102.12 (2012): e103-e110.
SOCIAL AND ENVIRONMENTAL FACTORS
Journals we follow:
American Journal of Preventive Medicine
American Journal of Public Health
Annual Review of Public Health
Journal of the American Medical Association (JAMA)
Journal of Epidemiology and Community Health
Journal of Health and Social Behavior
New England Journal of Medicine
Preventing Chronic Disease
Social Science and Medicine
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.