The Cost of Health Conditions in a Health Maintenance Organization

In this retrospective cohort analysis of all adults who were members of Kaiser Permanente, Northern California, between July 1995 and June 1996 (N = 2,076,303), the authors estimated the prevalence, average annual costs per person, and percentage of total direct medical expenditures attributable to...

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Bibliographic Details
Published in:Medical care research and review 2000-03, Vol.57 (1), p.92-109
Main Authors: Ray, G. Thomas, Collin, Francois, Lieu, Tracy, Fireman, Bruce, Colby, Chris J., Quesenberry, Charles P., Van Den Eeden, Stephen K., Selby, Joseph V.
Format: Article
Language:English
Subjects:
Acute Disease - economics
Adult
Age Distribution
Aged
Biological and medical sciences
California
Chronic Disease - economics
Comorbidity
Conditions
Costs
Diagnosis-Related Groups - economics
Direct Service Costs - statistics & numerical data
Disease
Female
General aspects
Health
Health care expenditures
Health maintenance organizations
Health Maintenance Organizations - economics
Health Maintenance Organizations - utilization
Health Services Research
Health systems. Social services
HMOs
Humans
Least-Squares Analysis
Male
Medical sciences
Middle Aged
Models, Econometric
Public health. Hygiene
Public health. Hygiene-occupational medicine
Retrospective Studies
Sensitivity and Specificity
Sex Distribution
USA
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Summary:In this retrospective cohort analysis of all adults who were members of Kaiser Permanente, Northern California, between July 1995 and June 1996 (N = 2,076,303), the authors estimated the prevalence, average annual costs per person, and percentage of total direct medical expenditures attributable to each of 25 chronic and acute conditions. Ordinary least squares regression was used to adjust for age, gender, and comorbidities. The costs attributable to the 25 conditions accounted for 78 percent of the health maintenance organization’s total direct medical expense for this age-group. Injury accounted for a higher proportion (11.5 percent) of expenditures than any other single condition. Three cardiovascular conditions—ischemic heart disease, hypertension, and congestive heart failure—together accounted for 17 percent of direct medical expense and separately accounted for 6.8 percent, 5.7 percent, and 4.0 percent, respectively. Renal failure ($22,636), colorectal cancer ($10,506), pneumonia ($9,499), and lung cancer ($8,612) were the most expensive conditions per person per year.
ISSN:1077-5587
1552-6801
DOI:10.1177/107755870005700106