Published: August 03, 2008 12:37 am      

Everyone pays for ‘sick’ lifestyles

The West Virginia Health Statistics Center named chronic diseases such as diabetes, arthritis and cancer as the leading causes of death in West Virginia, and the cost for chronic care is a heavy burden shared among all Mountain State residents.

Chronic illnesses are a rung on an economic ladder that starts with poverty and behavioral patterns and ends with hidden business taxes and government subsidies.

How We Got Here

A mix of underinsured individuals making poor choices creates much of the chronic situation West Virginia currently faces.

According to the Centers for Disease Control and Prevention, people with chronic diseases account for 83 percent of health care spending, 81 percent of hospital admissions, 76 percent of all physician visits and 91 percent of all prescriptions written nationwide. West Virginia ranks among the highest in the nation in both the incidence of disease and its risk factors, such as smoking and obesity.

“Every time you hear about a survey or anything like that, West Virginia does have high rates of a lot of the chronic diseases — higher rates than a lot of other states, so that creates a challenge for us,” said Chris Curtis, West Virginia’s public health commissioner. “Our economic situation, if you will, also creates some challenges in how we are able to provide care for folks who need it.”

In addition to the rates of chronic diseases, the number of West Virginians without adequate insurance causes concern, too, for the role that plays in disease prevention.

“In the short term and long term both, there’s no quick fix,” said Sen. Roman Prezioso, D-Marion, chairman of the Senate’s health and human resources committee. “We didn’t get into this situation overnight, and it’s going to take us a while to get through it, with a lot of behavioral modification.

“Right now, we’ve got a big problem with uninsured and underinsured, to provide people the opportunity to have regularly scheduled checkups and the help they need not to get into those chronic illness situations that cause the cost shift.”

West Virginia Insurance Commissioner Jane Cline said nationwide, about 60 percent of adults between ages 18 and 65 do not have health insurance.

Cline’s office pointed to U.S. Census Bureau numbers that show 15.2 percent of West Virginians were without health insurance in 2005.

Jessica Wright, director of chronic disease programs for the state’s Division of Health Promotion and Chronic Disease, said she leans on the state’s data when she looks at West Virginia’s chronic disease factors.

“I think back to the risk factor behaviors that are self-reported to us,” Wright said. “Those risk factors include the prevalence of smoking and tobacco use, and it goes back to how physically active we are on a daily basis, weight maintenance and eating enough fruits and vegetables.”

Wright said she thought it took many years for the state’s population to become chronically ill, so there is no easy solution.

Curtis cited today’s lifestyles and family structures.

“Our mamas today all work,” Curtis said. “And when they get off work, many of them don’t have a partner at home to help with the responsibilities; they’re tired, they pick their kids up from wherever they are, and everyone’s tired and cranky, so she sits them in front of the TV until she can quickly get something ready or get something from a drive-through.”

Curtis and Wright both said children can’t play freely in their neighborhoods anymore, leading to a culture of obesity.

“I don’t know the last time I’ve seen a kid out in any community biking,” Wright said. “I do believe that the more policies and the more scenarios where we can create health as the unconscious choice ... we’ll be better off.”

Chris Martin, associate professor and residency director of the IOEH occupational medicine training program, said medical students get course work in public health, and it’s now moving to the first year of curriculum.

“One of the things we teach them is the importance of socioeconomic status,” Martin said. “In fact, poverty is closely linked to health, but it’s not just about money. ... It’s about your place in society.

“People talk about racial inequalities in health, and West Virginia illustrates why that’s not true. In an overwhelmingly white state, we come very close to the bottom for all of these leading health indicators.”

Martin said another thing to consider is how society and the medical culture emphasize “heroic and dramatic acts of health care,” saying those specialists are paid the most money, and their projects always receive funding.

What’s the Cost?

As with most situations, the dollar amounts make up the bottom line.

Tom Susman, president of TSG Consulting, said West Virginia has a hidden tax on businesses and people who pay for health care, because neither state nor federal governments pay the full costs to deliver care for recipients of Medicare and Medicaid.

“In most states, there’s enough private business that cost shift is not a major problem, but in West Virginia, we don’t have that economic base,” Susman said. “So as a result, if I’m a small business person, 30 to probably 50 percent of my premium dollars are going to pick up the cost of government programs.”

Medicaid covers one out of every five West Virginians, and $315 million in taxpayer dollars went to the Medicaid program in 2006, according to the Kaiser Family Foundation. The West Virginia Health Statistics Center estimated that asthma, cardiovascular disease and chronic kidney disease cost West Virginia more than $893 million annually. The National Association of Chronic Disease Directors found that $445 is spent on medical treatment for chronic diseases for each $1 spent nationally on chronic disease prevention.

And the CDC said West Virginia’s aging population will drive the impact of chronic diseases and with it, “the necessity to improve peoples’ lives and contain costs.”

Prezioso said the Legislature would be more proactive with health care crises in the next regular session, and chronic illnesses that must be addressed year in and year out put tremendous burdens on the state’s budget.

“There’s not a lot of new dollars out there, and we have to make better utilization of the funds we have now,” Prezioso said. “It’s difficult to try to make the citizens of West Virginia realize they’ve got some responsibility too, and somebody’s going to pay for those chronic illnesses.”

Wright said chronic disease is taking up the biggest chunk of anyone’s budget.

“That’s what’s driving up the health care cost more than anything else,” she said. “We are spending it faster than we can put it in, and it’s not just business that’s going to bear the cost, but employees who work for the business.”

The National Governors Association purports that if one in 10 West Virginia adults started a regular walking program, the state would save $35 million each year in cardiovascular disease expenditures — the rough equivalent of sending about 6,000 Mountain State students to college.

The Centers for Disease Control and Prevention says the needs of people with chronic diseases will be the primary push for health care needs and their resulting costs into the “foreseeable future.”

An Ounce of Prevention

Information from the West Virginia Health Statistics Center confirms that while chronic diseases are the most costly and prevalent of health problems, they are the most preventable.

West Virginians may claim to be victims of many things, but making poor choices isn’t one of them, and Martin said he’s careful to teach medical students not to medicate non-medical problems.

“As physicians and public health advocates, we need to instill personal responsibility for health,” Martin said. “Everybody who’s smoking in West Virginia knows it’s bad for them, and you have to stay to people ‘This is something you bear responsibility for.’

“We look at medications to treat smoking cessation obesity, et cetera, when there are non-medical solutions. Everybody has to exercise and eat right and not smoke.”

Martin said the medical community has known for a long time that prevention is the most important health aspect, but diet and exercise initiatives, along with smoking cessation, isn’t very glamorous.

“The benefits are delayed, and it’s much more difficult to make the case for prevention,” he said. “Tobacco is considered the No. 1 modifiable risk factor, and studies vary as to what percentage of diseases and how much of an impact they have, but if you look at obesity, that is a risk factor for hypertension, type-2 diabetes, stroke and certain cancers as well — people don’t realize there’s the cancer link.”

West Virginia is trying to leverage its dollars for prevention, which includes insurance coverage.

AccessWV, a program that started about four years ago, provides insurance for individuals who can’t get insurance in the private marketplace, and it provides coverage for individuals who have pre-existing conditions, such as cancer or diabetes.

Curtis said she’s proud of the state’s high number, per capita, of primary care centers.

“Those are the clinics, if you will, that are funded some through federal mechanisms, some through the state,” she said. “They cannot turn anyone away, and they have to have a sliding fee scale. Part of their primary responsibility is to care for those folks who don’t have health insurance or other programs that don’t pay for their care.”

Curtis said Gov. Joe Manchin mandated uniform physicals for every child prior to entering kindergarten this year, so every single student received the same screening, regardless of coverage.

“In my opinion, we do a really good job with our children,” Curtis said. “We have the Medicaid program, CHIPS, and a large percentage of our children do have coverage through some mechanism.”

Wright said employers who are offering cash incentives for good health screenings are seeing success.

“They really are trying to make a difference because the bottom line is the dollar,” she said. “If they can put some money into keeping their employees healthy, it will pay off for them down the line.”

In a state where the largest employer is the state, any initiatives made by the Public Employees’ Insurance Agency will have sweeping effects. PEIA currently has diabetes and heart disease programs along with sliding premiums to reward good health.

Curtis said if she had unlimited funding for one program, her one wish would be to tackle childhood obesity.

“One of the things we’re really concerned about in West Virginia is childhood obesity,” she said. “We’re doing a lot of things to try to deal with that — we’re working in the schools, we’re working through various organizations and things, but somehow we need to have a way to support our families in that effort, because it’s much bigger than just what happens at the schools.”