Projecting future medical care costs using four scenarios of lifestyle risk rates

Purpose. This study predicts medical care expenditures over 10 years for Un ion Pacific Railroad (UPRR) under alternative health risk factor scenarios for the UPRR workforce. Design. This paper describes the development of an economic forecasting mod el to predict medical care expenditures assuming four different scenarios o f population risk. The variables used to predict medical care expenditures are employee demographics and health risk profiles. Setting. UPRR is a transportation company with more than 56,000 employees i n 25 states west and south of the Mississippi River subjects. Subjects. Employees of UPRR. Measures. Intermediate outcomes included health risk measures related to ex ercise pat terns, body weight, eating habits, smoking alcohol consumption, total cholesterol, blood glucose, blood pressure, stress, and depression. M ajor outcome measures included projected total annual payments by UPRR for medical care services for the decade following 1998. Results. The UPRR work force is projected to grow by 500 employees per year over the 10-year study period. The average age is expected to increase fro m 44 to 48 years. Without further health promotion intervention, 7 of the 1 1 risk factors assessed would likely worsen among UPRR's workforce. Medical care cost increases are projected to range from $22.2 million to $99.6 mil lion in constant 1998 dollars over the next decade, depending on the effect iveness of risk factor modification programs. With an expected health promo tion budget averaging $1.9 million annually over 10 years, health risks mus t decline at least 0.09% per year for the program to pay for itself. Conclusions. Estimating various risk and cost scenarios can facilitate prog ram planning and produce an economic justification for worksite health prog rams.