Health issues: it's not the money.

• Author: Mayberry, Anne

Introduction

Our health care system has changed considerably during the past 20 years. We've attempted to manage costs. We've begun to focus on quality. We anticipate we can improve the delivery of health care and in so doing, improve treatment and better manage costs. But a growing epidemic threatens our ability to address costly and chronic conditions such as diabetes and hear disease. Until our health care system can offer consumers comprehensive programs necessary to address obesity, we will continue to pay a premium for our health problems.

By many measures, we are healthier than ever. Although it's logical that the more we invest in health, the healthier we should become, many suggest that our health system is becoming increasingly inefficient, consuming larger and larger expenditures without a corresponding increase in the quality of care.

Take the example of a rapidly growing condition that promises to become far more costly during the next several years: obesity. This condition that kills over 300,000 annually, is a major cause of disease and disability, and is now classified as an epidemic. It costs us over $117 billion annually. Some studies suggest that expenses associated with this condition consume between 5 and 10 percent of total medical expenditures in the US annually. (1) Yet, in most cases treatment for obesity is not covered by health care.

OBESITY: THE UNTREATED EPIDEMIC?

Obesity is generally deemed a "lifestyle" condition, meaning that like many other diseases, it is generally triggered by the choices we make on a daily basis. Of the four key lifestyle risk factors linked to chronic health conditions, obesity is the most serious. Obesity affects more people and is more strongly linked to high rates of chronic illness. Unlike the other three--smoking, drinking and poverty--obesity is considered an epidemic in the U.S. (2)

Obesity is currently defined as an adult whose body mass index (BMI) is greater than 30. An overweight adult is one whose BMI is 25 and over. For example, an adult 5'6" who weighs between 155 and 185 is overweight; one who weighs over 185 is obese.

According to the Centers for Disease Control (CDC), while obesity is on the rise for all age and income groups, a disproportionate share--three quarters--of those defined as obese are age 51 to 69.

Causes of obesity are both medical and cultural. These include excessive eating, lack of exercise, genetic predisposition and endocrine disorders. Environment and culture, such as suburban living, which favors driving over walking, may also be considered factors in obesity.

"Obesity is a difficult issue to understand. We've just collectively discovered a number of problems associated with obesity," said Dr. Robert Friedland, director, Center on an Aging Society, Georgetown University. "It's not fair to blame the individual for obesity. Exercise and food may be a factor, but there are other reasons people are overweight. The link to other disorders has been underappreciated."

WHERE DOES THE OBESITY EPIDEMIC FIT IN OUR HEALTH SYSTEM?

Even with the new focus on health care quality, health policy analysts suggest that conditions like obesity represent a missing link that must addressed before we see improvement in health care quality and cost issues.

WHERE ARE CONSUMERS?

Our new demand for health care accountability and results is driving providers, insurers and employers to change the way they deliver and pay for health care. Employers can, to a degree, influence health care plans. Health plans can influence providers. Still, most consumers are still not well educated about either insurance plans or medical treatment options. This consumer gap limits health system improvements.

New initiatives designed to increase consumer participation embrace financial incentives and education as part of a performance-based health care system. These new initiatives anticipate that consumers will use both financial incentives and knowledge to make better health care choices.

Consumer-driven plans generally combine high deductible plans with some form of health spending account. But will they lead to more intelligent health purchases? While such plans were designed to encourage more consumer involvement in the health care purchasing process, employees view them suspiciously as the newest form of cost shifting. Employers, surveys show, are skeptical about the ability of new consumer plans to control costs or improve health care decision making. (3)

THE HEALTH CARE DEBATE: COMPLEX AND MULTIFACETED

It's been a good 20 years since health care issues first appeared on the scene, and even longer...