President's Page

President's Page
May 2007

Trimming the fat off healthcare costs

by James T. Norwood, MD
2007 DCMS President

I am writing this President’s Page just after returning from a First Tuesday in Austin. The healthcare needs for Texas seem enormous and ever increasing. All the 400 physicians and medical students who went to Austin on April 3 discussed with our elected officials the need for access to good health care in Texas. We also discussed the increase in demand for health care as our state’s population increases. A couple legislators were distressed at the enormity of how these expenses will increase and the increasing percentage of the total budget they will consume each year.

In an effort to control the situation, reigning in skyrocketing medical costs always is discussed. Medicaid reimbursement to physicians was cut in 2003 and, as a result, the percentage of Texas physicians treating Medicaid patients dropped from 67% in 2001 to 38% today. In Texas, Medicaid reimbursement no longer covers the expense of providing the service. For example, it costs physicians more than twice as much to give an immunization than what Medicaid reimburses. So, cutting physician reimbursement is not the answer. What can be done to decrease the cost of medical care in Texas? One solution could reduce healthcare costs directly by about 9 percent, and indirectly by even more. That solution is to trim the fat. By that, I mean that we need to get our overweight and obese patients to lose weight.

The CDC and the Sightline Institute calculated in 2004 that 9.1% of healthcare expenditures nationally were attributed to conditions brought on by being overweight. The burden of overweight patients (BMI between 25 and 29.9) increases average medical spending for every American by 14.5%. The added burden of obesity (BMI of 30 or greater) increases every American’s medical spending by 37.4%. A 2004 report by Finkelstein, Fiebelkorn, and Wang showed that 6.8% of Texas Medicare payments and 11.8% of Texas Medicaid payments were for the treatment of conditions arising from being obese (that doesn’t include overweight individuals—just the obese patients). In 2001 the TMA estimated that obesity-related spending in Texas was more than $10 billion. That is a big number when you keep in mind that Texas spent about $22 billion on all of its healthcare programs in 2003.

But today’s situation is even more dire than reported by Finkelstein, et al. First, their calculations are based on BMI statistics from 2003; today, even more people are overweight and obese. It is estimated that 63% of adults and 35% of school-age children in Texas are overweight or obese. Second, the numbers I have quoted so far are for prevention, diagnosis, treatment, and other money spent directly to treat obesity or its co-morbid conditions. Robert Rubin, MD, president of the Lewin Group, determined that a person with a BMI >35 has more than a sixfold higher risk for type II diabetes, fivefold increased risk for gallstones, threefold increased risk for hypertension and for arthritis, and twofold increased risk for a stroke when compared to a person with a BMI <25.

The indirect costs of treating overweight and obese patients also contribute significantly to increased healthcare spending, such as the need to purchase larger wheelchairs and sturdier OR tables, replace broken waiting room chairs, acquire longer OR instruments, and buy larger blood pressure cuffs.

Nonmedical indirect expenses related to obesity may surprise you. Forbes magazine reported that the increasing weight of Americans over the last decade forced the airline industry to use an extra 350 million gallons of fuel at an additional cost of $275 million. Research has shown that obese people miss work more often, costing employers $4 billion annually. In short, having a BMI >25 is bad for your health and bad for our economy.

Everyday, I advise patients on the benefits of weight loss, and I’m sure that most of our members do the same. The fact that Americans are getting heavier and more of them are considered obese is not news. Thank goodness the nonmedical world is catching on that obesity is a major health issue with a broad economic impact.

What more can we do as physicians and members of Dallas County Medical Society? Continue to educate our patients about the health risks and costs of weighing too much. Reinforce the many ways to lose weight and how it does not always require surgery or spending money at a gym or diet center. Voice your support to our legislators who are advocating healthy habits. For example, during this legislative session, Senator Jane Nelson (R-Flower Mound) and Representative Rob Eissler (R-The Woodlands) introduced bills mandating physical activity and fitness assessments for Texas students.

Just think: If we could eliminate obesity, blood pressures would drop, blood sugars would drop, death rates would drop, health expenses would drop, grocery bills would drop, employee absenteeism would drop, and maybe even airfares would drop.

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