Relationship between modifiable health risks and short-term health care charges

JAMA. 1999 Dec 15;282(23):2235-9. doi: 10.1001/jama.282.23.2235.


Context: If physical inactivity, obesity, and smoking status prove to contribute significantly to increased health care charges within a short period of time, health plans and payers may wish to invest in strategies to modify these risk factors. However, few data are available to guide such resource allocation decisions.

Objective: To examine the relationship of modifiable health risks to subsequent health care charges after controlling for age, race, sex, and chronic conditions.

Design, setting, and participants: Cohort study of a stratified random sample of 5689 adults (75.5% of total sample of 7535) aged 40 years or older who were enrolled in a Minnesota health plan and completed a 60-item questionnaire.

Main outcome measure: Resource use as measured by billed health care charges from July 1, 1995, to December 31, 1996, compared by health risk (physical activity, body mass index [BMI], and smoking status).

Results: The mean annual per patient charge in the total study population was $3570 (median, $600), and 15% of patients had no charges during the study period. After adjustment-for age, race, sex, and chronic disease status, physical activity (4.7% lower health care charges per active day per week), BMI (1.9% higher charges per BMI unit), current smoking status (18% higher charges), and history of tobacco use (25.8% higher charges) were prospectively related to health care charges over 18 months. Never-smokers with a BMI of 25 kg/m2 and who participated in physical activity 3 days per week had mean annual health care charges that were approximately 49% lower than physically inactive smokers with a BMI of 27.5 kg/m2.

Conclusions: Our data suggest that adverse health risks translate into significantly higher health care charges within 18 months. Health plans or payers seeking to minimize health care charges may wish to consider strategic investments in interventions that effectively modify adverse health risks.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Body Mass Index
  • Chronic Disease / economics*
  • Cohort Studies
  • Female
  • Health Behavior*
  • Health Care Costs / statistics & numerical data*
  • Health Care Rationing / statistics & numerical data*
  • Health Care Surveys
  • Health Status
  • Humans
  • Male
  • Managed Care Programs / economics*
  • Managed Care Programs / statistics & numerical data
  • Physical Fitness
  • Probability
  • Regression Analysis
  • Risk Factors
  • Smoking
  • United States