Ignoring Obesity May Drive Healthcare Spending Up

New analyses of healthcare spending bring two sharply contrasting trends into focus. It’s becoming increasingly clear that factors other than the weak economy and cost shifting to patients is holding back healthcare spending. Health economists are increasingly optimistic that these trends can be sustained. At the same time, Emory health economist Ken Thorpe presents a new analysis of the contribution of obesity and chronic diseases to spending growth. He warns that cost containment efforts are missing the point. Neglecting obesity and chronic diseases may render current strategies ineffective in the long-run.

In the first of a trio of publications in Health Affairs, Alexander Ryu and colleagues from Harvard demonstrated that structural changes account for half or more of the slowdown in healthcare spending over the last two years. They saw substantial reductions in the rate of spending growth in an insured population, even when adjusting for the effects of cost-shifing to patients. They conclude:

Given the evidence from our analyses, we believe that current trends support cautious optimism that the spending slowdown may persist — a change that, if borne out, could have a major impact on U.S. health spending projections and fiscal challenges facing the country, among other factors.

Building on this theme, David Cutler and Nikhil Sahni identified more than half of the recent slowdown in healthcare spending that the weak economy and cost shifing could not explain, except by fundmental changes in healthcare delivery. They conclude:

If these trends continue during 2013–22, public-sector health care spending will be as much as $770 billion less than predicted. Such lower levels of spending would have an enormous impact on the U.S. economy and on government and household finances.

And then Thorpe rains on their parade. Finding that obesity contributes substantially, consistently, and unabated to the growth in healthcare spending, Thorpe concludes:

The current findings strongly suggest that much of the recent discussion about how to control continuing increases in health care spending, particularly among Medicare beneficiaries, may be focused on the wrong set of issues.

For now, we are simply blaming people with obesity and leaving them with limited options for treatment and prevention until the obesity progresses to cause expensive chronic diseases. Sooner or later, sheer economics will force policy makers to do the right thing and address obesity objectively as a health issue.

Click here and here to read more in Modern Healthcare, click here, here, and here to read more in Health Affairs.

Medicine Costs image © StockMonkeys.com / flickr

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