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Modifiable Risk Factors May Increase Health Care Charges In The Short-Term:
Physical Inactivity, Smoking And Overweight Related To Increased Charges

CHICAGO - Unhealthful behavior may lead to significantly higher health care charges, according to an article in the December 15 issue of The Journal of the American Medical Association (JAMA).

Nicolaas P. Pronk, PhD, and colleagues at the HealthPartners Center for Health Promotion and HealthPartners Research Foundation, Minneapolis, randomly sampled 5,689 health plan enrollees aged 40 years or older. The researchers' goal: To determine the short-term health care charges related to physical inactivity, obesity, and smoking.

"In this study, we found that modifiable health risks were significantly related to higher health care charges, even after controlling for age, sex, race, diabetes, and heart disease," the researchers write. "Excess medical care charges related to physical inactivity, obesity, and smoking were substantial."

The researchers report that:

• Former smokers have 26 percent higher health care charges than never-smokers
• Current smokers have 18 percent higher medical care charges than never-smokers
• A one-unit increase in body mass index (BMI) raises medical charges by 1.9 percent (BMI is calculated as body weight in kilograms divided by height in meters squared. A "normal weight" target is a BMI of 19 to 25 units)
• Each additional day of physical activity per week reduces medical charges by 4.7 percent

The researchers say these "findings suggest that health plans that do not systematically support members' efforts to improve health-related behaviors may be incurring significant short-term health care charges that may be at least partly preventable.

"However, [this] study does not prove that changing modifiable health risks can reduce health care charges. The fraction of such charges that can be reversed is not yet known. To reduce charges, health plans would have to invest resources in effective intervention strategies to reduce the burden of modifiable health risks in members."

Other factors related to medical charges in this study:

• Each additional year of age raises medical charges 3.7 percent
• Males have medical charges 39 percent lower than females
• Whites have 27 percent lower medical charges than nonwhites
• Health plan members with diabetes have 137 percent higher medical charges than non-diabetic members
• Medical charges are 150 percent higher for health plan members with heart disease

The researchers conclude: "Health plans and self-insured employers seeking to maximize health return on each dollar spent for medical care may wish to consider strategic investments in interventions that effectively improve modifiable health risks. From a behavioral perspective, primary prevention of smoking and increased physical activity appear to have substantial potential to reduce health care charges."

This study was supported by a contract from HealthPartners to HealthPartners Research Foundation.

(JAMA. 1999; 282: 2235-2239)

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For more information: Contact the AMA's Bruce Kirkman Dixon at 312/464-4449, E-mail: bruce_dixon@ama-assn.org.