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Promoting Wellness and Prevention Return to Informing the Health Care Debate »
There is widespread consensus that healthy lifestyle choices including diet, exercise, and preventive screenings are vital to a healthy population. While there is also agreement about the negative impact of poor lifestyle choices, and that changes in these habits – either through organized programs or the efforts of individuals – could improve health, there is no consensus about how these changes would affect health spending. Governments, employers and health insurers have considered the use of incentives in public and private health insurance programs to promote behavior change with the expectation of improving health and saving money. RAND investigators have studied the effects of obesity and disease management programs on health and health spending.
Obesity
One of the leading causes of preventable illness in the U.S. is obesity. The biggest contributors to the obesity epidemic are poor diet and reduced physical activity. RAND researchers have conducted a series of studies analyzing obesity trends and estimating their effects on health care costs.
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Obesity in the U.S. population has been increasing steadily over the past two decades — and severe obesity is increasing the fastest. The recent sharp increase in bariatric surgery has not slowed this trend.
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Obesity is linked to higher rates of chronic disease than smoking, drinking, or poverty.
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Obese individuals incur higher total health care costs. Compared with their normal-weight counterparts, the obese will spend 36 percent more on health care services, and 77 percent more on medications. If historical trends continue through 2020, up to one-fifth of health care expenditures would be devoted to treating individuals with health problems attributable to obesity.
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RAND investigators have modeled the effect of obesity on lifetime health spending. They found savings to Medicare from reducing obesity; this was the only behavior change that resulted in savings for Medicare, although a strong link between lifetime health care costs and healthy behaviors has not been established.
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RAND's findings suggest that weight reduction should be an urgent public health priority.
Neighborhood characteristics can play an important role in prevention and wellness, primarily by stimulating exercise and reducing the risk of obesity.
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Living within a mile of a public park significantly increases the likelihood that residents will engage in exercise.
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Residents of socioeconomically disadvantaged neighborhoods have less access to fresh fruits and vegetables than their counterparts in better-off areas.
TopDisease Management
Disease management programs focus on individuals who already have chronic medical conditions. They often employ patient education, patient self-care management, provider training, and individualized care plans with the goal of increasing the delivery of appropriate health care services, improving health outcomes, and lowering health care costs. RAND has conducted studies of disease management and examined the literature to understand its effects on health care utilization and health care costs.
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Research evidence suggests that disease management may increase the delivery of appropriate health care, but the health effects are uncertain.
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In theory, disease management programs use up-front investments in care management services to achieve savings through decreased treatment costs over the longer term; however, evidence is mixed on the effect of disease management on spending.
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Disease management approaches vary widely. The effect of disease management on spending may differ depending on the disease management approach or the disease targeted.
Disease management programs may improve health outcomes, but may also increase costs. Promoting policy options that add value to the health system may be desirable, however such reforms will not necessarily constrain health care spending.