The Relationship between Modifiable Health Risks and Future Medical Care Expenditures: The Korea Medical Insurance Corporation (KMIC) Study

Influencing subjective well-being for business and sustainable development using big data and predictive regression analysis

Business leaders and policymakers within service economies are placing greater emphasis on well-being, given the role of workers in such settings. Whilst people's well-being can lead to economic growth, it can also have the opposite effect if overlooked. Therefore, enhancing subjective well-being (SWB) is pertinent for all organisations for the sustainable development of an economy. While health conditions were previously deemed the most reliable predictors, the availability of data on people's personal lifestyles now offers a new dimension into well-being for organisations. Using open data available from the national Annual Population Survey in the UK, which measures SWB, this research uncovered that among several independent variables to predict varying levels of people's perceived well-being, long-term health conditions, one's marital status, and age played a key role in SWB. The proposed model provides the key indicators of measuring SWB for organisations using big data.

Understanding the Relationship between Health Risks and Health-Related Costs

Dr. Anderson reflects on the lack of consistency in studies on the relationship between health risks and medical costs. Part of the inconsistency is caused by differences in risk assessment instruments, but a more important concern is lack of clear conceptualization and statement of research goals. One reason for exploring this relationship is to be able to predict health care costs accurately: a very different reason is to identify causal variables, the modification of which will have an impact on costs.

The Association between Health Risks and Medical Expenditures in a Japanese Corporation

Purpose.

To examine the relationship between health risks and medical care expenditures in an employer setting in Japan.

Design.

A cross-sectional, correlational study.

Setting.

A large Japanese corporation.

Subjects.

A total of 6543 employees of a large Japanese electronics company, for whom medical expenditures, lifestyle risks and biometric data were available, were included in the analysis. Seventy-six percent were male, and subjects were primarily white-collar workers.

Measures.

Medical expenditure data were available for fiscal year 2000, including inpatient, outpatient, and total expenditures, measured in Japanese yen. Binary expenditure indicators for those having no claims and those having high claims (90th percentile) were also created. Risk measures included biometric assessment of high blood pressure and high body mass index (BMI, body weight and height) and self-reported stress, lack of exercise, excess alcohol consumption, poor nutrition, current smoking, and recent quitting. High cholesterol and high blood glucose measures were also available for some subjects from company physicals.

Results.

Average total expenditures were ¥48,017 (US$445). The 90th percentile of the expenditure distribution was approximately ¥111,750 (US$1037). The most commonly reported risk factors were lack of exercise (52.9%), current smoking (35%), stress (33%), and poor nutritional habits (23.6%). Least common were recently quitting smoking (2%), high blood pressure (4.1%), and high blood glucose (9.4%). The prevalence of overweight or obesity was 15.9%. High blood pressure and recent quitting were consistently related to high expenditures, after adjusting for the influence of other predictors. Adjusted expenditures were 76% higher for recent quitters and 22.6% higher for employees with high blood pressure. Males and younger employees had consistently lower expenditures. Current smoking, poor nutrition, and alcohol risk were also associated with lower expenditures. Those with multiple cardiovascular risk factors had adjusted medical expenditures that were 128% higher than those with no cardiovascular risks. Those who had multiple risk factors for stroke had expenditures that were 13% lower than those without stroke risk factors.

Conclusions.

This paper represents a first step in examining the association between health risks and medical expenditures in Japanese employees. The investigation uncovered some significant levels of risk for lack of exercise, smoking, and stress. Although results indicate some significant associations between health risks and medical expenditures, several unexpected associations were noted that require further study. Such information provides a solid foundation for health promotion efforts in Japan and direction for subsequent investigations of health risks and medical expenditures. Future studies should address important issues of health risk measurement, data collection, and research design.

Impact of a Health Promotion Program on Employee Health Risks and Work Productivity

Purpose.

Evaluate the impact of a multicomponent workplace health promotion program on employee health risks and work productivity.

Design.

Quasi-experimental 12-month before-after intervention-control study.

Setting.

A multinational corporation headquartered in the United Kingdom.

Subjects.

Of 618 employees offered the program, 266 (43%) completed questionnaires before and after the program. A total of 1242 of 2500 (49.7%) of a control population also completed questionnaires 12 months apart.

Intervention.

A multicomponent health promotion program incorporating a health risk appraisal questionnaire, access to a tailored health improvement web portal, wellness literature, and seminars and workshops focused upon identified wellness issues.

Measures.

Outcomes were (1) cumulative count of health risk factors and the World Health Organization health and work performance questionnaire measures of (2) workplace absenteeism and (3) work performance.

Results.

After adjusting for baseline differences, improvements in all three outcomes were significantly greater in the intervention group compared with the control group. Mean excess reductions of 0.45 health risk factors and 0.36 monthly absenteeism days and a mean increase of 0.79 on the work performance scale were observed in the intervention group compared with the control group. The intervention yielded a positive return on investment, even using conservative assumptions about effect size estimation.

Conclusion.

The results suggest that a well-implemented multicomponent workplace health promotion program can produce sizeable changes in health risks and productivity.

Association between Lifestyle-Disease Diagnosis or Risk Status and Medical Care Costs in a Japanese Corporation

Purpose.

This study examined the differences in medical care costs among (1) individuals who carried the diagnosis of selected lifestyle diseases (diabetes mellitus, hypertension, and hyperlipidemia), (2) individuals whose levels of risks (blood glucose, blood pressure, and total cholesterol) satisfied the diagnosis guidelines yet who did not carry the diagnoses, (3) individuals who had these risks but whose risk levels were not high enough to satisfy the diagnosis guidelines, and (4) individuals without the risks.

Design.

A one-time cross-sectional design was used. Health checkup data and medical-claims data obtained from the fiscal year 2000 were examined for correlations.

Sample.

A total of 3292 employees aged 34 years and older were selected from the entire employee population of 6543 in a Japanese corporation. Employees younger than 34 years old were excluded because their clinical risk data were not available.

Measures.

On the basis of their absence or presence of diagnoses (obtained from medical claims) and underlying risk levels (obtained from health checkups), employees were categorized into (1) the diagnosed group, (2) the extremely high-risk group, (3) the high-risk group, or (4) the no-risk group. Reimbursement points on medical care claims were summed for each individual during the study period and multiplied by 10 to calculate the total medical care costs, as each point in the reimbursement request form represents ¥10.

Analysis.

The high-cost case analysis was used. First, the high costs were determined as the costs at or above the 90th percentile. The diagnosis or risk status was examined in its relation to the newly created dichotomous variable (whether the medical costs were at or above the threshold or were lower than the threshold) by using a χ2 test. Furthermore, excluding the diagnosed group, a χ2 test was performed to examine the relationships between the levels of risk and the likelihood of incurring any medical care costs (use vs. nonuse).

Results.

Approximately 15% of employees were already diagnosed with at least one of the three diseases (the diagnosed group; n = 490). One-quarter of employees had at least one risk that was high enough to be diagnosed with the corresponding disease if they had sought medical care (the extremely high-risk group; n = 809). There were 1343 employees in the high-risk group and 650 employees in the no-risk group. The diagnosed group had much higher chances of incurring medical care costs at or above the 90th percentile than did any other risk or no-risk group. No difference among the three risk or no-risk groups was found in mean medical care costs or in the likelihood of any use of medical care services after controlling for the effect of diagnosis.

Conclusions.

In a Japanese employee population, the diagnosis status of diabetes mellitus, hyperlipidemia, and hypertension was found to be associated with higher medical care costs while risk levels for the diseases were not in a 1-year time period.

Achievement of Target Blood Pressure Levels among Japanese Workers with Hypertension and Healthy Lifestyle Characteristics Associated with Therapeutic Failure

BACKGROUND

Few studies have examined Japanese with regard to the achievement rates for target blood pressure levels, or the relationship between these rates and healthy lifestyle characteristics in patients with hypertension as defined by the newly established hypertension management guidelines (JSH2014). The aim of this study was to elucidate achievement rates and examine healthy lifestyle characteristics associated with achievement status among Japanese.

METHODS

This cross-sectional study, conducted in January-December 2012, examined blood pressure control and healthy lifestyle characteristics in 8,001 Japanese workers with hypertension (mean age, 57.0 years; 78.8% were men) who participated in a workplace health checkup. Data were collected from workplace medical checkup records and participants' self-administered questionnaires. We divided into 5 groups [G1; young, middle-aged, and early-phase elderly patients (65-74 years old) without diabetes mellitus or chronic kidney disease (CKD) (<140/90 mmHg), G2; late-phase elderly patients (≥75 years old) without diabetes mellitus or CKD (<150/90 mmHg), G3; diabetic patients (<130/80 mmHg), G4; patients with CKD (<130/80 mmHg), and G5; patients with cerebrovascular and/or coronary artery diseases (<140/90 mmHg)] according to JSH2014. And then, achievement rates were calculated in each group. Multivariate analysis identified healthy lifestyle characteristics associated with "therapeutic failure" of target blood pressure.

RESULTS

Target blood pressures were achieved by 60.2% of young, middle-aged, and early-phase elderly patients (G1), 71.4% of late-phase elderly patients (G2), 30.5% of diabetic patients (G3), 33.4% of those with chronic kidney disease (G4), and 66.0% of those with cerebrovascular and/or coronary artery diseases (G5). A body mass index of 18.5-24.9 and non-daily alcohol consumption were protective factors, and adequate sleep was found to contribute to therapeutic success.

DISCUSSION

We found low achievement rates for treatment goals among patients with chronic kidney disease and diabetes mellitus. Maintaining an ideal body weight and adequate alcohol consumption may help with blood pressure control. Lifestyle modification may be necessary for better management of hypertension.

Sustained economic value of a wellness and disease prevention program: an 8-year longitudinal evaluation

The objective of this study was to determine the sustained economic impact of a health promotion/disease prevention program delivered through a large regional health plan. This was a retrospective analysis of health risk, health claims, and cost using a mixed model factorial design for the years 2002-2009 that compared program participants to nonparticipants. All analyses were adjusted for age, sex, morbidity, and baseline health care costs as appropriate. The findings presented herein indicate a positive return on investment (ROI) for each program year with ratios ranging from a low of 1.16:1 to a high of 2.83:1. The average ROI collapsed across all 8 years was 2.02:1. The 2009 ROI approximated over $6 million in total savings. This study demonstrates the sustained economic value of a comprehensive health promotion program.

Factors associated with metabolic syndrome and related medical costs by the scale of enterprise in Korea

OBJECTIVES

The purpose of this study was to identify the risk factors of metabolic syndrome (MS) and to analyze the relationship between the risk factors of MS and medical cost of major diseases related to MS in Korean workers, according to the scale of the enterprise.

METHODS

Data was obtained from annual physical examinations, health insurance qualification and premiums, and health insurance benefits of 4,094,217 male and female workers who underwent medical examinations provided by the National Health Insurance Corporation in 2009. Logistic regression analyses were used to the identify risk factors of MS and multiple regression was used to find factors associated with medical expenditures due to major diseases related to MS.

RESULT

The study found that low-income workers were more likely to work in small-scale enterprises. The prevalence rate of MS in males and females, respectively, was 17.2% and 9.4% in small-scale enterprises, 15.9% and 8.9% in medium-scale enterprises, and 15.9% and 5.5% in large-scale enterprises. The risks of MS increased with age, lower income status, and smoking in small-scale enterprise workers. The medical costs increased in workers with old age and past smoking history. There was also a gender difference in the pattern of medical expenditures related to MS.

CONCLUSIONS

Health promotion programs to manage metabolic syndrome should be developed to focus on workers who smoke, drink, and do little exercise in small scale enterprises.

The joint impact of cardiovascular risk factors upon medical costs

OBJECTIVE

The joint impact of obesity, hypertension, and hyperglycemia upon medical costs is not well known. Our objective was to evaluate the joint impact of these cardiovascular risk factors upon medical costs in the rural Japanese population.

METHODS

The data were derived from a 6-year prospective observation of National Health Insurance beneficiaries in rural Japan. Data on blood chemistry tests, blood pressure, weight, and height were obtained from an annual health check-up provided by the local municipalities in 1995. We prospectively collected data on medical costs over a 6-year period for 12,340 subjects (5306 men and 7034 women) without prior histories of cardiovascular disease or cancer.

RESULTS

Mean medical costs for individuals being overweight/obese, hypertensive, and hyperglycemic were 91.0% higher than those for individuals without any of these three cardiovascular risk factors. In this cohort, 17.2% of total medical costs were attributable to these three risk factors.

CONCLUSION

Overweight/obesity, hypertension, and hyperglycemia could have a large impact on health care resources in rural Japan.

Relationships between behavioral risk factors and dental care costs in a Japanese worksite

PURPOSE

To identify the magnitude of dental care costs and examine the relationship between behavioral risk factors and dental care costs in a Japanese corporation.

DESIGN

A one-time cross-sectional design was used with each employee as a unit of analysis.

SETTING

The setting was a large Japanese corporation where Japan's standard health care insurance, including dental care coverage, was provided for all employees.

SUBJECTS

A full-time employee population of 6543 was included. Seventy-six percent were men, and the majority were white-collar workers.

MEASURES

Data were available on dental care costs and self-reported behavioral dental care risk, including smoking and oral self-care, obtained from the company's annual physical checkups in the 2000 fiscal year Dichotomous variables of expenditures for employees having no dental claims and those having high claims defined as 90th percentile or above were created.

RESULTS

The dental care costs made up approximately 24.3% of the health care costs. Thirty-five percent of the employees were smokers. Employees who were at least 40 years old and employees who were women were associated with the likelihood of using dental care services (odds ratio [OR] = 1.622 and 0.783, respectively), and no behavioral risk was associated. The likelihood of incurring high dental care costs was associated with smoking when including all employees in addition to those who used any dental care services (OR = 1.315 and 1.386, respectively).

CONCLUSIONS

This study suggests the relationships of smoking as well as age and sex to dental care costs in an employer setting. To provide a strong case for health promotion in Japan, future research should address critical issues such as reliable and valid risk measurement and the use of longitudinal designs and intervention studies.

The development of a new corporate specific health risk measurement instrument, and its use in investigating the relationship between health and well-being and employee productivity

BACKGROUND

There is a growing body of evidence linking health and well-being to key business issues. Despite this, corporate uptake of workplace health promotion programmes has been slow outside the USA. One possible reason for this is the lack of a generally available health risk measure that is quick and easy to administer and produces data that is rich enough to inform and direct subsequent employee health promotional interventions.

METHODS

We report on the development and validation of the health and well-being (HWB) assessment, a free to use health risk appraisal questionnaire that has been specifically developed for use in the corporate setting. The HWB assessment focuses upon modifiable health issues that directly impact upon business drivers. Development involved interviews with business leaders to ascertain their key areas of focus, scientific and general literature review to find evidence for health status having an impact upon these areas, and end user testing.Three UK-based organisations (insurance, telecommunications and consumer goods sectors) participated in the research. A total of 2224 employees completed the HWB assessment, the short-form 36 (SF-36) and the World Health Organisation Health and Work Performance questionnaire (WHO-HPQ) as part of the validation process.

RESULTS

The HWB assessment is a twenty item questionnaire covering ten areas of health and well-being. Completion of the HWB assessment generates a global health risk score and ten sub-scores corresponding to the ten areas covered. It is easy to use and quick to complete (average completion time was eight minutes) and showed good internal consistency and test-retest reliability. Statistically significant correlations with similar SF-36 variables were observed. A significant negative correlation between HWB score and productivity decrement, as measured by the WHO-HPQ, was observed (r = -0.4). Individuals with HWB scores above the 25th percentile were more likely to achieve workplace productivity standards than those with scores below the 25th percentile (OR 3.62, 95% confidence limits 2.93 - 4.47).

CONCLUSION

The HWB assessment generates reliable business focused health risk data that can be used to direct and target appropriate interventions within corporate populations. It may also be useful in quantifying the financial impact health status issues have upon organisations.

Assessment of possible impact of a health promotion program in Korea from health risk trends in a longitudinally observed cohort

BACKGROUND: Longitudinally observed cohort data can be utilized to assess the potential for health promotion and healthcare planning by comparing the estimated risk factor trends of non-intervened with that of intervened. The paper seeks (1) to estimate a natural transition (patterns of movement between states) of health risk state from a Korean cohort data using a Markov model, (2) to derive an effective and necessary health promotion strategy for the population, and (3) to project a possible impact of an intervention program on health status. METHODS: The observed transition of health risk states in a Korean employee cohort was utilized to estimate the natural flow of aggregated health risk states from eight health risk measures using Markov chain models. In addition, a reinforced transition was simulated, given that a health promotion program was implemented for the cohort, to project a possible impact on improvement of health status. An intervened risk transition was obtained based on age, gender, and baseline risk state, adjusted to match with the Korean cohort, from a simulated random sample of a US employee population, where a health intervention was in place. RESULTS: The estimated natural flow (non-intervened), following Markov chain order 2, showed a decrease in low risk state by 3.1 percentage points in the Korean population while the simulated reinforced transition (intervened) projected an increase in low risk state by 7.5 percentage points. Estimated transitions of risk states demonstrated the necessity of not only the risk reduction but also low risk maintenance. CONCLUSIONS: The frame work of Markov chain efficiently estimated the trend, and captured the tendency in the natural flow. Given only a minimally intense health promotion program, potential risk reduction and low risk maintenance was projected.

Financial impact of health promotion programs: a comprehensive review of the literature

PURPOSE

The purpose of this review is to summarize the literature on the ability of health promotion programs to reduce employee-related health care expenditures and absenteeism. SEARCH PROCESS: Using key words in a literature-searching program, a comprehensive search was conducted on the following databases: MEDLINE, Embase, HealthSTAR. SPORTDiscus, PsycINFO, SciSearch, ERIC, and ABI Inform.

STUDY INCLUSION AND EXCLUSION CRITERIA

All data-based studies that appeared in peer reviewed journals in the English language. Theses, dissertations, or presentation abstracts that were not published in peer reviewed journals were excluded. The initial search identified 196 studies, but only 72 met the inclusion criteria and were included in the review.

DATA EXTRACTION METHODS

Summary tables were created that include design classification, subject size, results, and other key information for each study.

DATA SYNTHESIS

Both the nature of the findings and the overall quality of the literature were evaluated in an attempt to answer two questions: Do individuals or populations with high health risks have worse financial outcomes than individuals or populations with low health risks? Do health promotion programs improve financial outcomes?

MAJOR CONCLUSIONS

There are good correlational data to suggest that high levels of stress, excessive body weight, and multiple risk factors are associated with increased health care costs and illness-related absenteeism. The associations between seat belt use, cholesterol, diet, hypertension, and alcohol abuse and absenteeism and health care expenditures are either mixed or unknown. Health promotion programs are associated with lower levels of absenteeism and health care costs, and fitness programs are associated with reduced health care costs.