Do smokers and obese folks lower health care costs by dying sooner?

[Wowbagger]

That is what part of this article claims:
http://www.latimes.com/news/opinion/la-ed-health9feb09,0,7947137.story

We guffawed before we winced at the Dutch study published this week that found that slim and fit people actually cost the healthcare system more than obese people and smokers. That's because puffers and the pudgy tend to die young, while health nuts live longer and so rack up higher total medical bills.

I am a bit skeptical of this claim.

Anyone who knows more about this, than I do, care to comment?

 

[Jaggy Bunnet]

I have a vague recollection of a statistic showing that a staggering percentage of healthcare costs are incurred in the last six months of life. If that is the case (I will try and source it later) then presumably they are accelerating those costs.

However they probably do reduce pension costs.

 

[Skeptical Greg]

Nonsense ..

Here is one article from a quick on the cost of obesity ..

http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm

Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs.

It doesn't seem logical that fit non-smokers are more of a drain on the health care system than fat smokers...

Insurance companies pay close attention to that sort of thing.. If it were true, we would know about it..

 

[El Greco]

I don't know about the obese but the smokers sure pay more than their share if we include the taxes they pay for cigarettes. I'm grateful to smokers.

 

[fls]

Here is the study.

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050029

Doesn't this make sense, though? Even if your cost is less each year, if you live more years, your total cost may be higher. And those diseases not related to smoking and obesity may be relatively expensive.

ETA: This effect is consistently demonstrated in studies that show a substantial difference in life-expectancy - extending lives increases total expenditures.

Linda

 

[Skeptical Greg]

So, should everyone do their part now, by taking up smoking and getting fat ?

 

[Tricky]

Yes, they die sooner. They also get sick sooner.

 

[Lensman]

I don't know about the obese but the smokers sure pay more than their share if we include the taxes they pay for cigarettes. I'm grateful to smokers.

I've probably paid more into the NHS over the years, than I've taken out.

 

[Wowbagger]

Here is a way to think about it:

SIDS (Sudden Infant Death Syndrome) also causes people to die sooner. A lot sooner, in this case. You could argue that SIDS helps healthcare costs drop, as well.

Though, I suspect most people will reply: Yeah, but the point of healthcare is to keep people alive!

 

[TragicMonkey]

I don't think you can do an apples-to-apples comparison. The smokers and obese might avoid the age-related health expenses by dying sooner, but they surely cost more for the last stages of their life than healthy people the same age.

Betty Butterbuttocks was a healthy, nonsmoking, healthy-weighted individual. She lives to be 90, and her only serious health problems were age-related heart issues and some arthritis.

Doris Donkeywaffles was an overweight chain smoker. She died from a heart attack at 45, after five years of treatment for lung cancer.

Betty has a whole 45 years more of health expenses than Doris. But Doris racked up hundreds of thousands of dollars in costs for her last five years, while Betty at the same age did not. The only way to assess which cost more, overall, is to wait til both die and add up the bills.

 

[fls]

A cost-effectiveness study makes comparisons on the basis of cost (per outcome). A cost-benefit study makes comparisons on the basis of benefit (per unit of cost). It is usual for cost-effectiveness studies to show this kind of result - increasing lethality is associated with decreasing costs.

ETA: The reason you find this disturbing, is that while the outcomes are assumed to be the same (i.e. a lifetime) we value those lifetimes differently (shorter, reduced quality vs. longer, better quality).

Linda

 

[YoPopa]

I don't think you can do an apples-to-apples comparison. The smokers and obese might avoid the age-related health expenses by dying sooner, but they surely cost more for the last stages of their life than healthy people the same age.

Do you actually know any healthy dead people TM?

 

[Sir Robin Goodfellow]

Someone once said to me that you might as well smoke and drink and do what you want because you're just going to die anyway. I replied that if that's the case you might as well just quit your job, stop showering, brushing your teeth, and so on because you're just going to die anyway. Hey, you might as well just jump in front of a bus, you're just going to die anyway.


I've also been told by this person that you're going to get old and infirm and crippled so you might as well just smoke and do drugs. I replied that if you live a life of some common sense and moderation, you might have good quality of life at an advanced age.


I also like those guys who like to point out the famous health and fitness person who died of a heart attack at a young age (that figure skater dude, or some guy with a TV show about exercise back in the seventies, or Sergei Zholtok, or some other reasonably fit person), as if saying that the most prudent course of action is a life of excess and bad habits.

 

[rjh01]

Has anybody thought about the benefits of keeping people alive and in the workforce? Most people in the workforce pay taxes and produce more goods and services than they consume. It is best to keep most people alive until they retire at an old age. Then they are a drain on society.

 

[Jaggy Bunnet]

I don't think you can do an apples-to-apples comparison. The smokers and obese might avoid the age-related health expenses by dying sooner, but they surely cost more for the last stages of their life than healthy people the same age.

Betty Butterbuttocks was a healthy, nonsmoking, healthy-weighted individual. She lives to be 90, and her only serious health problems were age-related heart issues and some arthritis.

Doris Donkeywaffles was an overweight chain smoker. She died from a heart attack at 45, after five years of treatment for lung cancer.

Betty has a whole 45 years more of health expenses than Doris. But Doris racked up hundreds of thousands of dollars in costs for her last five years, while Betty at the same age did not. The only way to assess which cost more, overall, is to wait til both die and add up the bills.

On the other hand, the smokers and obese are more likely to keel over with a heart attack than those who take care of themselves. That would represent a low cost death.

 

[TragicMonkey]

On the other hand, the smokers and obese are more likely to keel over with a heart attack than those who take care of themselves. That would represent a low cost death.

Unless they had four or five previous heart attacks, and were on expensive blood thinners to reduce the risk, and then their heirs decided to sue Phillip-Morris.

I really don't think an apples-to-apples comparison is possible, and that any conclusions drawn from comparing the two groups of people are going to be such generalizations that they are meaningless. We're talking about whole lifetimes of variables in play, here. Insurance, occupation, genetics, family life, geographic location, education, diet, personality...I think there is too much underlying complexity behind "health" to conclude anything at all here.

 

[fls]

Has anybody thought about the benefits of keeping people alive and in the workforce? Most people in the workforce pay taxes and produce more goods and services than they consume. It is best to keep most people alive until they retire at an old age. Then they are a drain on society.

Yes. That would be a cost-benefit study.

A cost-effectiveness study compares costs to achieve a specific outcome. For example, you might compare the cost of preventing one heart attack using angioplasty with the cost of preventing one heart attack using medical therapy (note, this takes into consideration the number people you need to treat in order to prevent one heart attack). Because medical therapy is less expensive, the cost per prevented heart attack may be less for medical therapy.

A cost-utility study assigns a utility value to the outcome, such as quality-adjusted life years (QALY). So two interventions may be compared on the basis of cost per year of QALY. If angioplasty is more effective at preventing heart attacks, it will result in a greater number of QALY, so that the cost per QALY may be less than that of medical therapy.

A cost-benefit study involves outcomes that have a dollar value, so a ratio of benefit over cost in dollars can be calculated. Productivity is often used to assign a dollar value to health (as per your original question).

This particular study was a cost-effectiveness study where the outcome was 'a lifetime'. The cost per lifetime was calculated for each of the groups. Under these circumstances, all lifetimes are considered equivalent. Whether or not these lifetimes are actually equivalent (clearly they weren't from our perspective) is a different question, and one that was not relevant to the purpose of the study.

The problem is not with the study, but with attempting to draw conclusions from the study that it was not designed to support.

Linda

 

[Wowbagger]

The problem is not with the study, but with attempting to draw conclusions from the study that it was not designed to support.

That could well be a good summary, of these issues, right there!

 

[Darth Rotor]

That is what part of this article claims:
http://www.latimes.com/news/opinion/la-ed-health9feb09,0,7947137.story

Do smokers and obese folks lower health care costs by dying sooner?

Following that train of thought, is there any reason not to encourage suicide? It would reduce the burden on the health care system, incrementally lower the carbon footprint of a given social structure, and with any luck reduce the "per capita drama queen" demographic. (Drama queen used in this sense is intended to be gender neutral. Perhaps "emotional basket case" would have been a better term.)

Hmmm, where is the downside here?

DR

 

[rjh01]

And if you encourage suicide when a person has just retired then the cost is small and the benefit is enormous. They may be able to look after their grandchildren, but that is about all.