Healthcare Policy & Economics

Unit 3 Project Information Resources are relatively scarce related to wants. To strike a balance between scarce resources and unlimited wants involves making choices. Medical decisions involve costs and benefits. It is important to strike a balance between incremental benefits and costs. Decision making is seldom based on an all or nothing situation, but usually involves tradeoffs. For example, if we are to spend more on MRIs, than we need to spend a little less on mental health services.

There is a strong and growing interest among public health professionals in the broader societal trends and policies that affect physical activity behavior. Policies can be defined as laws, regulations, and rules (both formal and informal). Polices can be directed toward creating supportive environments and can also have direct effects on behavior by providing the basis for educational and behavior change programs, for instance. Overall there are a variety of factors that play a role in obesity. This makes it a complex health issue to address. This section will address how behavior, environment, and genetic factors may have an effect in causing people to be overweight and obese. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity 2001 identified action steps for several locations that may help prevent and decrease obesity and overweight. The following table provides some examples of these steps. Location Steps to Help Prevent and Decrease Overweight and Obesity

Home • Reduce time spent watching television and in other sedentary behaviors • Build physical activity into regular routines

Schools • Ensure that the school breakfast and lunch programs meet nutrition standards

• Provide food options that are low in fat, calories, and added sugars • Provide all children, from prekindergarten through grade 12, with quality

daily physical education

Work • Create more opportunities for physical activity at work sites

Community • Promote healthier choices including at least 5 servings of fruits and vegetables a day, and reasonable portion sizes Encourage the food industry to provide reasonable food and beverage portion sizes Encourage food outlets to increase the availability of low-calorie, nutritious food items Create opportunities for physical activity in communities

Overweight and obesity and their associated health problems have a significant economic impact on the U.S. health care system (USDHHS, 2001). According to a study of national costs attributed to both overweight (BMI 25–29.9) and obesity (BMI greater than 30), medical expenses accounted for 9.1 percent of total U.S. medical expenditures in 1998 and may have reached as high as $78.5 billion ($92.6 billion in 2002 dollars) (Finkelstein, Fiebelkorn, and Wang, 2003). Approximately half of these costs were paid by Medicaid and Medicare. Table 1 shows the estimated percentage of total, Medicare, and Medicaid adult medical expenses that are attributable to obesity.

Table 1, Estimated Adult Obesity-Attributable Percentages and Expenditures, by State (BRFSS 1998–2000)

State

Total population

(%) (Millions

$)

Medicare population

(%) (Millions

$)

Medicaid population

(%) (Millions

$)

Alabama 6.3 $1320 7.7 $341 9.9 $269 Alaska 6.7 $195 7.7 $17 8.2 $29 Arizona 4.0 $752 3.9 $154 13.5* $242 Arkansas 6.0 $663 7.0 $171 11.5 $180 California 5.5 $7675 6.1 $1738 10.0 $1713 Colorado 5.1 $874 5.1 $139 8.7 $158 Connecticut 4.3 $856 6.5 $246 11.0 $419 Delaware 5.1 $207 9.8 $57 13.8 $66 District of Columbia

6.7 $372 6.5 $64 12.5 $114

Florida 5.1 $3987 6.1 $1290 11.6 $900 Georgia 6.0 $2133 7.1 $405 10.1 $385 Hawaii 4.9 $290 4.8 $30 11.2 $90 Idaho 5.3 $227 5.6 $40 12.0 $69 Illinois 6.1 $3439 7.8 $805 12.3 $1045 Indiana 6.0 $1637 7.2 $379 15.7 $522 Iowa 6.0 $783 7.5 $165 9.4 $198 Kansas 5.5 $657 6.4 $138 10.2* $143 Kentucky 6.2 $1163 7.5 $270 11.4 $340 Louisiana 6.4 $1373 7.4 $402 12.9 $525 Maine 5.6 $357 5.7 $66 10.7 $137 Maryland 6.0 $1533 7.7 $368 12.9 $391 Massachusetts 4.7 $1822 5.6 $446 7.8 $618 Michigan 6.5 $2931 7.8 $748 13.2 $882 Minnesota 5.0 $1307 6.6 $227 8.6 $325 Mississippi 6.5 $757 8.1 $223 11.6 $221 Missouri 6.1 $1636 7.1 $413 11.9 $454 Montana 4.9 $175 6.2 $41 9.8 $48 Nebraska 5.8 $454 7.0 $94 10.3 $114 Nevada 4.8 $337 5.0 $74 10.1* $56 New Hampshire

5.0 $302 5.4 $46 8.6* $79

New Jersey 5.5 $2342 7.1 $591 9.8 $630 New Mexico 4.8 $324 4.6 $51 8.5 $84 New York 5.5 $6080 6.7 $1391 9.5 $3539 North 6.0 $2138 7.0 $448 11.5 $662

Carolina

North Dakota 6.1 $209 7.7 $45 11.7 $55 Oklahoma 6.0 $854 7.0 $227 9.9 $163 Ohio 6.1 $3304 7.7 $839 10.3 $914 Oregon 5.7 $781 6.0 $145 8.8 $180 Pennsylvania 6.2 $4138 7.4 $1187 11.6 $1219 Puerto Rico 7.4 8.1 10.1 Rhode Island 5.2 $305 6.5 $83 7.7 $89 South Carolina 6.2 $1060 7.7 $242 10.6 $285 South Dakota 5.3 $195 5.9 $36 9.9 $45 Tennessee 6.4 $1840 7.6 $433 10.5 $488 Texas 6.1 $5340 6.8 $1209 11.8 $1177 Utah 5.2 $393 5.8 $62 9.0 $71 Vermont 5.3 $141 6.9 $29 8.6 $40 Virginia 5.7 $1641 6.7 $320 13.1 $374 Washington 5.4 $1330 6.0 $236 9.9 $365 West Virginia 6.4 $588 7.3 $140 11.4 $187 Wisconsin 5.8 $1486 7.7 $306 9.1 $320 Wyoming 4.9 $87 5.9 $15 8.5 $23 Total 5.7 $75,051 6.8 $17,701 10.6 $21,329 *Estimates based on fewer than 20 observations. Source: Finkelstein, Fiebelkorn, and Wang, 2004. Re fe re n c e s (NHANES) National Health and Nutrition Examination Survey 1999–2000 Finkelstein, EA, Fiebelkorn, IC, Wang, G. National medical spending attributable to overweight and obesity: How much, and who's paying? Health Affairs 2003;W3;219–226. Finkelstein, EA, Fiebelkorn, IC, Wang, G. State-level estimates of annual medical expenditures attributable to obesity. Obesity Research 2004;12(1):18–24. U.S. Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease overweight and obesity. [Rockville, MD]: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; [2001]. Available from: US GPO, Washington.

Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obesity Research.1998;6(2):97–106.

Wolf, A. What is the economic case for treating obesity? Obesity Research. 1998;6(suppl)2S–7S.