The relationship between modifiable health risks and group-level health care expenditures

Purpose. To assess the relationship between modifiable health risks and tot al health care expenditures for a large employee group. Design. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data fr om employers' fee-for-service plans over the 6-year study period. Setting. The setting was worksite health promotion programs sponsored by si x large private-sector and public-sector employers. Subjects. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Measures. Eleven risk factors (exercise, alcohol use, eating current and fo rmer tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-pa rt regression model, controlling for demographics and other confounders. Ri sk prevalence data were used to estimate group-level impact of risks on exp enditures. Results. Risk factors were associated with 25% of total expenditures. Stres s was the most costly factor, with tobacco use, overweight, and lack of exe rcise also being linked to substantial expenditures. Conclusions. Modifiable risk factors contribute substantially to overall he alth care expenditures. Health promotion programs that reduce these risks m ay be beneficial for employers in controlling health care costs.