Health care cost drivers: Chronic disease, comorbidity, and health risk factors in the U.S. and Michigan

August 3, 2010

Elderly couple taking medicine.In the wake of national health reform, health systems, health plans, providers, and policy makers will be discussing what can be done to contain health care costs — within the provisions of reform or beyond them. For that discussion, it will be important to understand that health care spending is not distributed evenly across the population—or by condition. In fact, just five percent of the U.S. population—those with the most complex and extensive medical conditions—accounts for almost half (49 percent) of total U.S. health care spending, and 20 percent of the population accounts for 80 percent of total spending.

Chronic conditions are the leading cause of death and disability in the U.S., and treating patients with comorbid chronic conditions costs up to seven times as much as treating patients who have only one chronic condition. Modifiable health risk factors, such as cigarette smoking and overweight/obesity, are responsible for much of the illness, healthcare utilization, and subsequent costs related to chronic disease.

In our January 2010 issue brief, The Cost Burden of Disease, we presented the most common reasons for hospitalizations, the most expensive conditions, and gender differences between men and women with respect to the top ten diagnoses. In this issue brief, we focus on costs and risk factors relating to selected chronic conditions, comorbidities, and health risk factors of cigarette smoking and overweight/obesity.

As we collectively seek ways to address the crisis of rising costs—as part of overall health reform or through regional, state, or local approaches—we must understand the factors that drive health care costs and where opportunities exist to affect those drivers. This issue brief, and our issue briefs on overall costs and the cost burden of disease, are part of a larger report on health care costs, designed to stimulate thinking and further analysis about opportunities for change in health policy, medical practice—even personal health choices—that could lead to more effective and efficient health care spending.


Suggested citation: Ehrlich, Emily; Kofke-Egger, Heather, Udow-Phillips, Marianne. Health Care Cost Drivers: Chronic Disease, Comorbidity, and Health Risk Factors in the U.S. and Michigan. August 2010. Center for Healthcare Research & Transformation. Ann Arbor, MI.

[Revised with minor corrections, including re-numbered figures, on September 24, 2010.]