Healthcare Outlook - Genes, Environment, and Lifestyle

Goals

To obtain insights on how genes, the environment, and lifestyle will impact future health costs for the purposes of creating a presentation.

Early Findings

Preliminary research indicates that genes, the environment, and lifestyle currently have a major impact on health costs and will continue to do so in the future unless interventions are made.

GENES

  • According to a research study published in Nature, "pediatric inpatients with diagnostic codes linked to genetic disease have a significant and disproportionate impact on resources and costs in the US health-care system." This suggests that genetic diseases will continue to cost more than other health issues.
  • Patients with suspected genetic diseases are "high utilizers of health care" and correspond to an additional $12,000 to $77,000 per discharge compared with people who do not have genetic diseases.
  • Overall, patients with indications of genetic disease "showed a mean incremental total cost per discharge of $13,999, suggesting that more complex cases result in higher health-care utilization."
  • Of pediatric discharges in 2012, 2.6% to 14% were for genetic disease, but the costs associated with those discharges represented 11% to 46% of the pediatric "national bill."
  • While gene therapy could potentially "positively affect millions of lives," they are expected to be "costly, particularly if they are administered as single or short-term treatments, and are likely to pose major affordability challenges."
  • Health budgets of public insurers are already strained and "based on the initial pricing experience with gene therapy in Europe, should a growing number of gene therapies come into use at costs of US$1–2 million, the cumulative budget impact would be very substantial, and perhaps unsustainable."
  • Even if cost savings with gene therapy are realized over time by preventing long-term care, "the health system will be confronted with the challenge of absorbing upfront treatment prices over US$1 million per patient for even a relatively small number of patients."

ENVIRONMENT

  • A 2018 study indicated that there will be 2.5 million cases of non-communicable diseases associated with air pollution by 2035, which makes "air pollution an important public health priority."
  • Air pollution is currently the "leading environmental cause of early death—contributing to the equivalent of 5% of all deaths globally and an estimated 40,000 premature deaths each year in the UK."
  • In the UK, healthcare costs related to air pollution are estimated to be between £8.5 billion and £20.2 billion per year.
  • In 2015, "diseases caused by air, water and soil pollution were responsible for 9 million premature deaths, that is 16% of all global death."
  • Almost all of these deaths (92%) were in poorer nations, but the global financial costs of pollution are estimated at $4.6 trillion per year.

LIFESTYLE

  • U.S. health care costs for chronic diseases such as heart disease, cancer, diabetes, and Alzheimer’s reached $1.1 trillion in 2016.
  • The lifestyle factors of being overweight or obese accounted for 47% of the total chronic health care costs, while 8.7% was attributed to cigarette smoking, and 1% was attributed to excessive alcohol drinking.
  • As of 2015, nearly 40% of Americans are considered obese and another 33% are considered overweight. Research has "established a strong link between obesity and chronic diseases such as heart disease, kidney disease, and several types of cancers."
  • The Partnership to Fight Chronic Disease estimates that 83 million Americans will have three or more chronic conditions by 2030.
  • A 2017 study found that healthy lifestyles lead to an increased utilization of preventive health services, and did not show a significant decrease in outpatient visits.
  • According to the Centers for Disease Control and Prevention, in 2010, 86% of all healthcare spending "went toward people with one or more chronic conditions."
  • The Complete Health Improvement Program (CHIP), which is an initiative that promotes a health lifestyle, reduced outpatient medical visits of participants between 11% and 25% over a year when implemented as a workplace program.
  • According to Steve Burd, founder and CEO of Burd Health, indicated he was able to lower his company's healthcare costs by 40% and cut employees' costs by 10% with the implementation of "voluntary, company-wide wellness initiatives that provided monetary incentives for maintaining healthy lifestyles."
  • A study funded by the National Dairy Council found that increasing Americans' adherence to healthy diet patterns by 20% could "save more than $20 billion in direct and indirect costs."
  • Meal delivery programs like Meals on Wheels reduce the healthcare costs in Medicare and Medicaid beneficiaries.

Proposed next steps:

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As the initial research found significant information on how genes, the environment, and lifestyle currently impact and will impact healthcare costs, we recommend continued research into specific lifestyle issues such as obesity, smoking, and drinking to determine how each of those impact global healthcare costs.
We also recommend a breakdown of how various chronic conditions separately impact healthcare costs to focus on heart disease, cancer, diabetes, and Alzheimer’s.