ARE HEALTH RISKS RELATED TO MEDICAL-CARE CHARGES IN THE SHORT-TERM - CHALLENGING TRADITIONAL ASSUMPTIONS

Purpose. This study examines the association between self-reported hea lth risks and short-term use of medical resources. Design. Cross-secti onal study comparing responses from a mailed survey with medical encou nter and expenditure data. Bivariate analyses and multivariate linear and logistic regressions controlling for age, gender and health status were conducted to illustrate the relationship between selected risk f actors and resource use. Setting. A group network model health mainten ance organization (HMO) in Minneapolis, Minnesota. Subjects. The study population was comprised of a randomly selected sample of nonsenior a dults (18 to 64 years old, n = 3825) and seniors (65 years and older; n = 1955) who were enrolled in an HMO. The response rate was 72%. Meas ures. Five independent variables: smoking, alcohol use, obesity, lack of physical activity, and unhappiness were derived from a questionnair e designed to assess health status and health risks. Outcome measures were medical care charges and utse of hospital services. Results. Obes ity, physical inactivity and unhappiness were related to higher charge s among- seniors. These relationships dissipated to some degree after controlling for age, gender and health status. Unexpected differences were found for alcohol use among both age groups, with those considere d to be ''not at risk'' accruing higher charges and demonstrating a hi gher likelihood of using inpatient hospital services than those define d to be at risk. Conclusion Bivariate and multivariate regression resu lts demonstrated that traditional risk factors are weak and inconsiste nt predictors of short-term medical charges. Charging smokers and othe r high risk individuals a higher annual insurance premium than is offe red for those at low risk raises questions about fairness when such ri sk factors are not necessarily good predictors of short-term resource use. The rationale for insurance cost-shifting should be supported wit h reliable data connecting risks to charges.