Obesity set to become a greater health care cost driver
Specifically, the increase in extreme obesity among Americans will drive costs higher.
Obesity, not surprisingly, is a key driver of increased health care spending and reduced life expectancy in the United States. In 2016 alone, total medical costs attributable to obesity were $126 billion.
BMC Public Health recently analyzed the effect of obesity on health care spending from 2006 to 2016. The study looked at service line (emergency, inpatient and outpatient) and payer, using Body Mass Index categories from the National Institutes of Health. Researchers found that spending associated with obesity and overweight has changed in some important ways over the past 10 years.
Related: 16 states now have obesity rates above 35%
Spending increasingly is focused on individuals in Obesity Class 3 (extreme). These individuals are 5% of the total population, and only about one in six obese persons falls into this class, yet more than a quarter of obesity-related costs are concentrated in this group. This is the group that is proportionately growing the fastest, with a 32% increase over the past decade.
For other weight classes, spending has been more effectively controlled, and total spending has been relatively flat. This is due largely to a shift from inpatient to outpatient care, coupled with slight reductions in prescription drug spending. Also, despite the coverage expansions in the Affordable Care Act, the majority of spending remains paid for by private insurance ($67 billion) rather than Medicare ($43 billion) or Medicaid ($16 billion).
“Overall, we find that the obesity-attributable fraction of health care spending has actually declined over the past decade, despite increased obesity and overweight prevalence,” according to the report. “Our results suggest this success is due to the shift from inpatient to outpatient settings for care.”
Two conclusions can be drawn from the study:
First, obesity has not been the key driver of increases in health care spending over the past decade. Obesity-related spending has increased, but other spending has increased faster.
Second, obesity may be a more important cost driver in the coming decade. The proportion of the population that is obese is increasing. Over the past decade, the increased prevalence was offset with changes in the pattern of spending — inpatient to non-inpatient — which moderated the increase.
“Without further reductions in per capita spending, the effect of increases in the proportion of the population which is obese may have a larger effect on health care spending,” researchers concluded. “This is particularly true because of the increase in extreme obesity. Future efforts to control obesity-related spending are likely to be most impactful if they concentrate on individuals with BMI over 40, as well as preventing individuals from progressing to high levels of obesity.”
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