Obesity Driving Medicare Costs Higher

http://www.forbes.com/forbeslife/health/feeds/hscout/2006/08/22/hscout534510.html

TUESDAY, Aug. 22 (HealthDay News) -- The epidemic of obesity sweeping
America is the prime culprit behind recent sharp increases in Medicare
spending, researchers report.

The reason: Older, heavier people are much more likely to enter the
program with pre-existing medical issues, the experts say.

"The rise in Medicare spending is largely traced to the doubling of
obesity among the elderly and obesity-related conditions like diabetes,
high blood pressure, bad cholesterol and so on," said lead author
Kenneth E. Thorpe, the Robert W. Woodruff Professor and Chair of the
Rollins School of Public Health at Emory University, Atlanta.

However, policy makers are not taking the burden of obesity and its
related illnesses into account as they look at ways to reduce costs to
preserve Medicare, experts say.

While increases in the program's cost have been attributed to causes
such as medication costs, hospital and doctors fees, 90 percent of the
increases can be attributed to people entering the program with
diabetes, metabolic syndrome and other diseases associated with
obesity, concluded a report published in the Aug. 22 online issue of
Health Affairs.

The researchers analyzed data from two major federal studies --
published in 1987 and 2002 -- to assess trends for disease prevalence
and Medicare expenditures.

They found that the number of obese Medicare recipients nearly doubled
during that time period, while the cost of treating these patients
nearly tripled -- from 9.4 percent of Medicare spending in 1987 to 25
percent of expenditures by 2002.

The number of patients receiving treatment for five or more medical
conditions also rose -- from 31 percent in 1987 to more than half of
recipients in 2002. These patients used up more than three-quarters of
Medicare spending by 2002, compared to 52 percent of expenditures in
1987.

In addition, Thorpe said, almost half the Medicare population meets the
clinical definition of "metabolic syndrome" -- a collection of
unhealthy factors, including hypertension, cholesterol abnormalities, a
waist circumference greater than 40 inches in men and 35 inches in
women, and hyperglycemia. Studies have shown that people with metabolic
syndrome have a 1.5 times increased risk for coronary heart disease.

"Physicians are [also] much more aggressively treating patients today
compared to even five to 10 years ago," Thorpe pointed out.

That's true even for non-obese patients. In their study, Thorpe and his
colleague David Howard found the number of normal-weight Medicare
patients being treated for five or more conditions rose from 11.5
percent in 1987 to 16 percent in 2002. The portion of Medicare costs
earmarked for these patients rose from 19.6 percent in 1987 to 24.1
percent in 2002, the study found.

More aggressive treatment does help patients, of course. In 2002,
almost 60 percent of Medicare patients being treated for five or more
conditions said they were in excellent or good health, compared with 33
percent of similar patients in 1987, Thorpe and Howard found.

But as a larger number of unhealthy Medicare recipients live longer,
costs rise.

Many of the factors driving these trends are being ignored, Thorpe
said.

"Most of the debate about how to deal with the growth in entitlements
really is ignoring these key facts," he said. "Most of the reforms on
the table have nothing to do with what's driving the growth of Medicare
spending up in the first place," he added.

Real efforts to stop the obesity epidemic could put the brakes on this
trend, Thorpe said. "We need to recognize that we need to do much more
in terms of primary prevention -- diet, exercise and nutrition -- not
only among the existing Medicare beneficiaries, but among the
near-elderly, those 55 to 64," he said. "These people will be entering
Medicare with rates of chronic disease disability that we have never
seen."

According to the researcher, heightened awareness of the dangers of
smoking has cut the number of people smoking from 30 percent to 20
percent since the 1950s. Similar programs might curb obesity, too.

One expert agreed that people need to make significant lifestyle
changes to bring down Medicare costs and improve their health.

"There is a great need to get to people before they even enter
Medicare," said Mary R. Grealy, chair of Medicare Today and president,
Healthcare Leadership Council, a medical industry lobbing group. "But,
at any age, there are things people can do to make lifestyle changes
and reduce the incidence of disease and the need for a variety of
medications," she added.

Grealy believes that, in addition to government programs, private
employers and health insurers need to concentrate on obesity, diabetes
and other conditions linked with being overweight to curb health care
costs. "We really have to focus on prevention," she said.

Another expert thinks that extending Medicare to younger people --
those aged 55 to 64 -- would bring a lot of healthier people into the
program before chronic illness appears. That could save dollars, said
Robert M. Hayes, the president of the Medicare Rights Center, a
consumer watchdog group.

"It's common sense," said Hayes. "If we give people better care, they
will be healthier and live longer," he added.

"A lot of us think that extending Medicare eligibility to people 55 to
64 would be a good idea," Hayes said. "Because a lot of folks in the
decade before eligibility lose their employment, lose their health
coverage and are effectively uninsured. They hit Medicare coverage in
pretty bad shape. It would be a humanitarian and cost-effective measure
to figure out how to bring people into Medicare before age 65."