Top 10 Per­sonal Health Ex­penses From Diabetes To Preg­nancy

ForbesWeekly - - NEWS - BY BRUCE JAPSEN, FORBES CON­TRIB­U­TOR

The cost of diabetes, heart dis­ease and back pain are tak­ing a greater toll on the U.S. econ­omy, with th­ese con­di­tions and in­juries dom­i­nat­ing per­sonal health­care spend­ing, au­thors of a new study say.

They are among only 20 of 155 con­di­tions that ac­count for more than half of all U.S. health spend­ing, re­searchers led by the Univer­sity of Wash­ing­ton wrote in the study, pub­lished in the Dec. 27 Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion. Diabetes, the top spend­ing cat­e­gory, ac­counted for more than $100 bil­lion in per­sonal health spend­ing.

Re­searchers looked at the con­di­tions and dis­eases over an 18-year pe­riod through 2013 that are driv­ing U.S. health spend­ing, which ac­counts for 17% of the U.S. econ­omy. “The top 10 or 20 things aren’t al­ways things that peo­ple are think­ing of,” Joseph Diele­man, as­sis­tant pro­fes­sor at the Univer­sity of Wash­ing­ton’s In­sti­tute for Health Met­rics and Eval­u­a­tion and the pa­per’s lead au­thor, said in an in­ter­view.

Here are the top 10 health ex­penses:

1. Diabetes: $101.4 bil­lion 2. Heart dis­ease: $88.1 bil­lion 3. Low back and neck pain: $87.6 bil­lion 4. Hy­per­ten­sion: $83.9 bil­lion 5. In­juries from falls: $76.3 bil­lion 6. De­pres­sive dis­or­ders: $71.1 bil­lion 7. Oral surgery (fill­ings, ex­trac­tions, den­tures): $66.4 bil­lion 8. Vi­sion and hear­ing: $59 bil­lion 9. Skin (cel­luli­tis, acne): $55.7 bil­lion 10. Preg­nancy and post­par­tum care: $55.6 bil­lion

Can­cer was not among the top 20 con­di­tions with high spend­ing in the study’s re­port be­cause the dis­ease was “dis­ag­gre­gated into 29 con­di­tions,” the re­port states. “It’s not that we don’t spend much on can­cer; it’s be­cause we spend a lot of money on all of the other con­di­tions,” Diele­man said.

To cur­tail health spend­ing, pri­vate in­sur­ers and Medi­care are mov­ing to value-based ap­proaches in an at­tempt to spend more up­front on well­ness, out­pa­tient care and out­reach to make sure pa­tients are get­ting what they need be­fore con­di­tions be­come more costly if they are ne­glected.

Aetna, Unit­edHealth Group, An­them and most Blue Cross and Blue Shield plans are shift­ing tens of bil­lions of dol­lars in what they pay doc­tors and hos­pi­tals from fee-for-ser­vice medicine that re­wards vol­ume of care de­liv­ered to val­ue­based ap­proaches.

“The tra­jec­tory of health­care costs could be im­pacted by a stronger fo­cus on the pre­ventabil­ity as­pects of th­ese con­di­tions, but it’s not the way re­sources are al­lo­cated across the coun­try,” Derek Yach, chief health of­fi­cer of Vi­tal­ity In­sti­tute, one of the study’s spon­sors, said in an in­ter­view. “Fee-forser­vice is an in­ef­fec­tive way to man­age long-term health­care costs.”

In the case of diabetes, in­sur­ers and med­i­cal care providers have their work cut out for them. Diabetes costs rose 36 times faster over the 18-year study pe­riod than cost of is­chemic heart dis­ease gen­er­ally im­pact­ing those 65 and older, the study in­di­cates.

“Diabetes in and of it­self is a story,” said Diele­man. “That in­crease has been in all types of care.”

LUKAS SCHULZE/GETTY IMAGES

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