The Cost of Chronic Disease and What To Do About It

August 9, 2010

This past week, our Center released a report on the cost of chronic disease in Michigan. As we noted in that report, nationally, five percent of the U.S. population accounts for almost half of all health care spending and 20 percent accounts for 80 percent. In addition, according to the U.S. Department of Health & Human Services, chronic disease accounts for 7 out of 10 deaths annually in the United States.

In our report, we noted that for Blue Cross and Blue Shield of Michigan in 2008, those with no chronic conditions cost an average of $2,800 annually. By way of comparison, those with congestive health failure, the most expensive chronic condition we profiled, cost an average of $41,000 annually. Those with three or more chronic conditions incurred 10 times the medical expense of those with no chronic conditions.

What is particularly important to note about the conditions we profiled is that some of the most significant complications and resultant costs are either entirely or partially preventable. Hospitalizations associated with coronary artery disease, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and asthma are all considered by the Agency for Health Care Research to be preventable. And, many would contend that early treatment would also prevent a significant amount of hospitalizations associated with mental disorders and osteoarthritis (the other conditions covered in our report).

And, perhaps even more significantly, many of these conditions could be entirely prevented in many people. The risk factors of obesity and smoking underlie many of these conditions and either cause or exacerbate them. While the number of smokers in our state and country has declined, smoking rates are still too high: 20.5 percent in Michigan and 18.4 percent in the U.S. overall (Michigan ranks 16th highest nationally in the relative percentage of smokers). And, obesity is increasing dramatically in our state and country. 29.5 percent of those in Michigan were considered obese in 2008 and 26.7 percent in the U.S. overall. Michigan’s obesity rate was 9th highest in the U.S.

So, the key take-away from this issue brief should be: we can do something about these issues. First of all, we know many things that work to reduce chronic disease. Value based insurance design encourages early intervention by reducing the barriers to needed and proven treatments. Community based strategies can help by preventing many of these diseases: indeed, we now have years of research on approaches that work to reduce smoking, and we know a lot can be done to keep people from smoking in the first place (or help them quit if they already smoke). Higher cigarette taxes, certain stop smoking campaigns, and laws that require smoke free work places all have been shown to work.

The research is less clear on what makes the most difference in reducing obesity (we know that bariatric surgery works to help those who are already obese but we know less about what is effective for keeping people from becoming obese in the first place). We do know the importance of multipronged strategies and working with schools and communities to help prevent childhood obesity.

We also know that we can’t afford to focus on just one issue when it comes to chronic disease. Steve Schroeder and Ken Warner made a powerful argument in the New England Journal of Medicine , reminding us that we have not won the war on tobacco use in this country. They pointed out that too many foundations and others have shifted their priorities toward reducing obesity, at the expense of initiatives to reduce the use of tobacco. And, while we clearly do need to focus on obesity, it shouldn’t be either/or. If we are going to really change the trajectory of chronic disease in this country – along with the attendant human misery and costs – we absolutely must use every proven tool and strategy we have. Prevention is the goal, but early intervention can make a huge and important difference, too.