Some less well known costs of obesity

I've commented many times on obesity over the past couple of years of writing in this blog space.  Here is a link to a Baltimore Sun piece about some less well known costs of obesity.

The key question is just which portion of these costs get captured in most economic evaluations of efforts to reduce obesity.  And, looking at which appears in the text, just how are we defining obesity.  The text of the article uses the term "mild obesity".  In the most recent reading I'd done on the topic, this was referred to as "overweight but not obese".  Yes, it is all a matter of semantics as it is the same BMI range-more than 25 and less than 30.  (I'm lucky enough to be just under 22.5 and still I try to be careful.)  But labeling does make a difference in how people interpret the information.  All the stuff that we used to say about "stick and stones may break my bones but names will never hurt me"--probably bogus.  Words matter.  Perceptions matter.  Perceptions affect behaviors and behaviors affect people's weight, health, and their notions of whether they can do much about it.

The costs that I have not seen before are things like the cost of extra airline fuel to carry passengers.  I'm not sure whether those numbers are literally just for the passengers' weight or also, presumably, for the extra clothing and perhaps even larger luggage.  Same goes for cars carrying people.  And, even more interestingly, if those change, then what about all the other effects such as how the increasing price of fuel will change the amount of money people have to spend for other things.

We can realistically only trace the effects so far.  The key is that the numbers of dollars and cents may be a bit bigger than we had previously anticipated.  

Medicare's Poor Incentivizing

Today's Johns Hopkins Bloomberg School of Public Health news feed provided a link to an article on what has been described as waste in the Medicare system.  The key is that as part of the health care reform legislation back in 2010, payments to most Medicare managed care plans were cut, but there was an incentive created to make bonus payments to plans that offer high quality care.

The concern now is that that the bonus payments have been given to plans with only mediocre quality care.  The plan has cost more than was intended as the bonuses have gone to many more plans than were expected.  It may seem patently obvious but giving bonuses to a large number of plans with so-so quality will not provide any incentive to provide care at the highest quality level.  That type of incentive might have been given by using the same amount of money (or perhaps even less) to provide a significant bonus to a smaller number of Medicare plans.

The Obama administration claims that it will not cancel the program as it is still expected to help to improve the quality of care being provided.

This is obviously highly questionable, and, if the newspaper story is correct, this is not likely to be a cost-effective way to improve the quality of care.

While the amount of money is small relative to the entire health care or Medicare budget is small, the principle is that making poor use of even small amounts of resources will sooner or later add up to poor uses of large amounts of resources.

Something to think about as we move forward with the implementation (or not) of the health care reform legislation from 2010. 

"Americans Still Not Exercising"

I put the title for this week's blog post in quotes as it is the exact title of the article that you can find by clicking here.  This is a short piece in the Baltimore Sun that came to my attention this morning thanks to the Johns Hopkins Bloomberg School of Public Health News Feed.  The title is pretty self-explanatory and the news "bite" is shorter than this blog entry will be.

First, let's acknowledge one thing.  The survey that says fewer people are active was conducted by...the Sporting Goods Manufacturers Association.  The fact that they have an incentive to tell people they are not sufficiently active so they can sell more goods is not lost on me.

Second, the change in the number of inactive adults over a one year period was a 1.6 percent increase--noticeable but not huge.  What is more noticeable is the 8 percent increase in a three year time period.  The article does not make clear whether that is adjusted for population growth or not, but 8 percent in three years is certainly more than could be accounted for by population growth.

Third, the piece says that Utah is the most active area.  Here, the article makes a distinction between regular exercise and complete non-participation.  I am not sure what it is about Utah, but it seems like a place that has great skiing, moderate temps for part of the year, and a lot of open space.  Since hiking and camping are activities listed, this may help to account for some of this difference.

Fourth, the piece comments that southern states are less active.  I'm not sure that could explain complete non-participation, but I could certainly see regular exercise being an issue for those who don't have a climate controlled place in which they can exercise.

Fifth, the article points out that hiking and camping are growing in popularity.  At least hiking is something that does not necessarily require organization, can be social as well as physical, does not require a gym membership, and can be done with little planning ahead.  It seems like a lot of forces in people's lives might push them toward this type of activity.

Finally, there is also the comment that yoga and boot camp classes are popular.  I don't participate in either regularly but I have done each at different points in time.  I would be very interested to know what brings more people to each of two very different activities.  I don't have a strong hypothesis about this one other than a general trendiness of each.

So, the brief news piece does not have all bad news, but does leave us to wonder what incentives or information could be used to move the 24 percent of US adults labeled as inactive (i.e., no participate in any of 119 possible activities) to do something.

Female Condom Distribution in Washington DC

The chair of the Department of Health Behavior and Society at the Johns Hopkins Bloomberg School of Public Health was a coauthor on a recent study that was featured in an article in the Washington Post.  The program that was funded consisted of the distribution of female condoms and a program to encourage women to feel comfortable talking about sexual health.

This article looks at the number of female condoms that were distributed, assumes the number that were actually used, and projects the number of HIV cases that were prevented.  Then, it used an assumption about the lifetime cost of HIV infection ($367,314) and projected the total savings associated with the program.  The lifetime savings were much greater than the cost of buying the female condoms, distributing them, and running the program to encourage women to feel more comfortable about discussing sexual health.

The analysis seems reasonable.  It is important to consider a few things for the economic implications of the study and what else we might expect to see in the long-run.

(1) Will the cost of female condoms change in the future?  Probably.  Of course there is general price inflation, but the key question is whether the relative price will change.  In general, the cost of items at a specific level of quality generally go down over time.

(2) Will the cost of managing HIV over a lifetime change?  Again, probably.  Here we must consider the combination of general price inflation versus relative inflation and the many changes that occur in the price of pharmaceutical products over time.

(3) Will the distribution of who is paying the medical care costs change over time?  This is rather unpredictable until the court case focusing on the Affordable Care Act is decided.

(4) Does the distribution of who is paying the medical care costs matter?  It probably does.  It was nice to have funds to obtain the female condoms to distribute for free.  However, will this continue?  If it does not is there any way to get those who will benefit from female condom use to pay for the condoms to distribute?  Who benefits?  The women--suggesting that a free market decision might work, although obviously we wouldn't need free distribution if the free market solution already worked.  Insurers--they benefit later.  A local public health department would not benefit as it does not pay for most (or perhaps any) of the care.

(5) Does the distribution of female condoms change people's sexual behavior other than getting at least some of them to use the female condoms?  Some worry that when individuals feel safer in having sex, those individuals will have sex more often with more partners.  Is this true? Perhaps, but not necessarily.

(6) Would simply trying to encourage people to avoid non-monogamous sex work?  Then, there would not be the cost of the condoms themselves and, for those who use the approach successfully, there is no failure.  There is, of course, a risk of failing to stick with it.  Whatever we as individuals may think of non-monogamous sex, evidence suggests this doesn't work.

So, would anything likely change the favorable economic outcome suggested by this analysis?  Probably not enough to change the conclusion that distribution of female condoms seems to save a lot of money at the societal level.  The key, politically, would seem to be to find a way to make sure that there is some way for those being asked to pay for the distribution to benefit from the savings.