The relationship between modifiable health risks and group-level health care expenditures
The relationship between modifiable health risks and group-level health care expenditures
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DOI：
10.4278/0890-1171-15.1.45
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发表时间：
2000-09-01
影响因子：
2.7
通讯作者：
Serxner, S
中科院分区：
文献类型：
--
作者：
Anderson, DR;Whitmer, RW;Serxner, S
目的。评估一个大型员工群体的可调整健康风险与医疗保健总支出之间的关系。风险数据是通过自愿参加健康风险评估（HRA）和工作场所生物识别筛查收集的，并在个人层面上与6年研究期间雇主付费服务计划的医疗保健计划登记和支出数据联系起来。研究的背景是由六家大型私营部门和公共部门雇主赞助的工作场所健康促进项目。在完成人力资源调查（HRA）的50%员工中，46,026人（74.7%）符合分析的所有纳入标准。11个危险因素（运动、饮酒、饮食、现在和以前吸烟、抑郁、压力、血压、胆固醇、体重和血糖）被分为高风险和低风险水平。风险和支出之间的关联使用两部分回归模型进行估计，控制人口统计和其他混杂因素。风险流行率数据用于估计群体层面风险对支出的影响。风险因素与总支出的25%有关。压力是最昂贵的因素，吸烟、超重和缺乏锻炼也与大量支出有关。可改变的风险因素对总体卫生保健支出有很大贡献。降低这些风险的健康促进计划可能有利于雇主控制医疗保健费用。
Purpose. To assess the relationship between modifiable health risks and total health care expenditures for a large employee group.Design. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period.Setting. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers.Subjects. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis.Measures. Eleven risk factors (exercise, alcohol use, eating current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures.Results. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures.Conclusions. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.