The high cost of asthma

[Guest guest]

Asthma Prevalence Rates and Employer-Paid Costs: Implications for

Employers and Physicians By ADAM LONG, PhD

Asthma is a major concern for employers.

Research out of Harvard Medical School has shown that asthmatics have

absenteeism and “presenteeism†(impaired while at work) rates in excess of

other,

healthier employees.

Annual numbers per asthmatic total 10.8 days absenteeism and 18.3 days

presenteeism. Combined, those numbers account for nearly 20 work days per

asthmatic per year in lost productivity. Uncontrolled or poorly managed asthma

also

results in emergency room visits and inpatient stays that cost employers even

more.

It is little wonder, then, that the majority of large employers engage

disease management vendors to reach out to asthma patients to encourage them to

follow their doctors’ recommendations and coach them in better

self-management

of their condition. Other employers are also engaging lifestyle coaching

services.

The employer’s hope is often that, through early detection via health risk

assessment and assistance with lifestyle changes, the asthmatic will be able

to lead a personal and occupational life that keeps him or her happy and

productive and avoids altogether the serious medical events that trigger

disease

management efforts in the first place.

Gordian Health Solutions offers services that examine lifestyle, behavior,

and self-management along with benchmarks that further the goal of helping

employers develop specific interventions and wellness programs that foster

healthy behavior for asthmatics.

In its extensive work over the past 11 years with large national employers,

Gordian Health Solutions has accumulated nearly $5 billion in claims data

from 61 organizations that can inform this discovery process. And because cost

data comes from claims paid by employers, results are very relevant to

employers’ bottom lines.

Gordian also assists physicians in better understanding asthma prevalence

rates compared to employer-paid medical (non-pharmaceutical) costs for asthma,

with the goal that observed differences will spark innovative treatment

ideas.

According to the Centers for Disease Control and Prevention, nearly 10

percent of males under the age of 18 are diagnosed with asthma as compared to

7.3

percent for females in the same age group. However, females’ risk of asthma

increases gradually over their lifetime to 9.6 percent for those aged 55-64,

while males’ risk decreases sharply with age. Less than 6 percent of men of

ages 18-24 have asthma, and less than 5 percent of older men (ages 25 and

above) have it. The figures mean that boys are 36 percent more likely than

girls

to have childhood asthma, but in adults, women have roughly twice the asthma

rates of men. But do employers’ medical costs for asthma parallel these

prevalence rates?

Curiously, only the proportion of asthma costs by gender within these age

ranges mirror the CDC’s findings: Boys account for more than 55 percent of

children’s asthma costs while women account for as much as 62 percent of

adult

asthma costs. Looking at men and women separately, however, shows different

asthma cost patterns. For example, though middle-aged men have the lowest

asthma

prevalence (<5 percent), those aged 30-44 account for the highest

proportion (28 percent) of all male asthma costs – higher even than boys

under 18 (25

percent), whose prevalence rate is twice that of middle-aged men.

Most interesting of all might be the asthma cost data that controls for the

number of members, i.e., per member per month (PMPM) costs. Males’ PMPM

medical (non-phar¬m¬a¬¬ceuti¬cal) costs for asthma are in fact inverse

their

prevalence rates up to age 44 – with steady increases from $2.28 (<18 years)

to

$3.03 (30-44 years), after which they settle at about $2.68 PMPM. Females’

PMPM

asthma costs, on the other hand, do mirror their prevalence rates, with

relatively low costs for girls and young adults ($1.94) and a steady cost

increase with age to $3.12 PMPM for those aged 55-64.

The most intriguing and perhaps most relevant finding with respect to

employers’ attempts at healthcare demand management is that PMPM asthma costs

for

young men aged 19-29 and 30-44 exceed those of young women by 47 percent and

18 percent, respectively, despite the fact that women’s asthma prevalence

rates exceed men’s for these same age ranges by 59 percent and 73 percent,

respectively.

This finding is perhaps best explained by gender differences in healthcare

consumption behavior. Men generally avoid the healthcare system until they

need it most, which likely results in higher cost care per episode. Women see

their physician more regularly but are also more likely to be hospitalized for

asthma, even when symptoms are equivalent to men’s.

The conclusion? Men may need their employer’s push to better self-manage

asthma, while women may need self-management aids that give them greater

control

over symptom severity. Many employers can lower healthcare benefits costs

while at the same time helping employees have a better quality of life by

engaging a professional with expertise to help employers educate both men and

women in the best ways to manage their own disease.

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[Guest guest]

It isn't just employers who pay extra. We all pay extra, especially those

who can't work or get insurance because of asthma.

Some people even die from it. And that not even looking at the changes they

must make in their lives, the things they can't do.

So, when mold causes asthma, somebody rich might be saving money on building

maintenance, but they are basically getting an involuntary gift of that

money from those they make ill, and society.

We can't afford these subsidies from poor people to these businesses.