Study puts injuries at top of cost list
May be useful reference for smaller work sites
Those impressive databases that track employee conditions and identify high-risk conditions are wonderful resources, but not every work site has the budget available to take that approach. However, there are other guidelines employee health professionals can use to gain some insight as to what conditions may not only pose the greatest threat to employee health, but also have the largest impact on the company’s bottom line.
One potential source is a study conducted in Northern California by Kaiser Permanente, based in Oakland, which was published in the March 2000 Medical Care Research and Review. The study, conducted between 1995 and 1996, tracked the prevalence, average annual cost per person, and percentage of total direct medical expenditures attributable to each of 25 chronic and acute conditions (see box, right). The study surveyed 2.7 million individuals; not only is the population large enough to be considered representative of the broader population in the United States, but since it "somewhat underrepresents the unemployed, the aged, and people with very low education and income,"1 it tracks a working population even more closely.
What did the study find? "Injury accounted for a higher proportion (11.5%) of expenditures than any other condition. Three cardiovascular conditions — ischemic heart disease, hypertension, and congestive heart failure — together accounted for 17% of direct medical expense and separately accounted for 6.8%, 5.7%, and 4%, respectively. Renal failure ($22,636), colorectal cancer ($10,506), pneumonia ($9,499), and lung cancer ($8,612) were the most expensive conditions per person per year."
Using study as a reference tool
Can a study such as this be confidently used to establish benchmarks for employee populations for which scant statistics are available? The article’s authors seem to think so. "By quantifying and ranking the most common acute and chronic conditions in a large managed care population, we believe this study will be useful to those . . . setting priorities for prevention programs," they wrote.
"Because the population is so large and we have such a large market share, it is fairly representative of the population of Northern California," says G. Thomas Ray, MBA, of the division of research at Kaiser, and the article’s lead author. "And it certainly is one of the largest studies of its type using this methodology to try to estimate costs." He adds that the findings are even similar to those of other large studies that may have used a different technique.
That being the case, health promotion professionals would be well advised to pay particularly close attention to injuries; but just what injuries are we talking about? "For the purposes of our study, these would be any on- or off-the-job injuries that would have shown up in the Kaiser system," says Ray.
Employers should consider adding educational programs that help prevent injuries off the job, as well as on, says Ray. "Kaiser has sponsored some outreach programs to encourage the wearing of bike helmets and seat belts," he notes. "Our perspective as health care providers is to see what we can do that would most effectively focus our efforts in terms of health care dollars."
Since the study was conducted a few years ago, has Ray noticed any new trends that might have shown a different emphasis in the findings? "I doubt that there would be significant differences," he concludes.
[For further information, contact: G. Thomas Ray, Division of Research, Kaiser Permanente, 3505 Broadway, Oakland, CA 94611. Telephone: (510) 450-2084. Fax: (510) 450-2070. E-mail: [email protected].]
Reference
1. Ray GT, Collin F, Lieu T, et al. The cost of health conditions in a health maintenance organization. Medical Care Research and Review 2000; 57:92-109.
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