Comparing changes in health risk factors and medical costs over time

Purpose. This study was designed to examine the association between health status/behaviors and changes in these measures over time with health costs. Design. This study employed a 6-year (1993-1998) retrospective cohort design to examine the relationship between health indicator variables, health insurance costs, and utilization. The outcome variables of interest were measures of health insurance costs and utilization of health care services. Setting. Public employer located in the northeastern United States. Subjects. In all, 1940 employees were included in the study on the basis of their membership in the worksite health plan and their having complete health indicator data collected during each of the two time periods (1993-1995 and 1996-1998). Measures. The health insurance data were obtained directly from the organization's Third Party Administrator. The health indicator variables included blood pressure, cholesterol, body mass index, and smoking status. Results. At-risk employees had a greater probability of submitting health insurance claims than did no-risk employees in approximately 70% of the 18 Major Diagnostic Codes that were examined. Higher costs were associated with the at-risk classification (mean = $3237 and median = $433) over time, and lower costs (mean = $1626 and median = $49) were associated with maintaining a no-risk status over time. Conclusions. These findings support the notions that lower health risk and maintaining a no-risk status over time are associated with lower health insurance costs.