Health inequalities in the US currently cost $320 billion a year and could rise to $1 trillion by 2040 as the population becomes less white, per capita spending increases, and Medicaid enrollment grows. new report in consultation with the giant Deloitte.
The findings serve as a reminder to stakeholders that unless they take action to correct health inequalities in a health care system that is already taking a heavy toll in human life, they too will lose money.
“This should be a call to action for organizations up to this point,” said Andy Davis, FSA, MAAA, Deloitte’s chief actuary, who advises hospitals, healthcare systems and pharmaceutical companies, as well as other clients across industries. MedPage Today.
To calculate how much health inequality is costing now and extrapolate its financial losses into the future, the company focused on differences in health outcomes that arise due to gender, race, or socioeconomic status of patients in several affected populations. from inequality in various disease states.
For example, black adults are 60% more likely to be diagnosed with diabetes than white adults and are two to three times more likely to experience complications such as amputation and end-stage renal disease. The researchers found that 4.8% of diabetes spending is attributable to this mismatch, resulting in $15 billion in unnecessary spending.
The researchers also reviewed the literature among studies with data on differences across populations to understand rates of additional disease conditions such as asthma, heart disease, breast cancer, and colorectal cancer.
While there are disparities other than gender/sex, race and class, such as age and ability, Deloitte’s actuaries have focused on the most well-documented issues. They also accounted for the intersectional effects of inequality—for example, a low-income Hispanic woman may experience prejudice that is exacerbated by race, class, as well as gender in the health care system.
According to the report, the actuaries were conservative in their cost estimates. In reality, the cost of not acting on health inequalities can be much higher, as actuaries cannot explain how each disease can affect the other and affect health care costs.
While “math modeling gets us very close” to accurately calculating these costs, “the problem is probably bigger than the model predicts,” said Leslie Rennis, MD, Edd, assistant professor at CUNY Manhattan Community College. and an expert in public health research and evaluation.
However, “the analysis does an excellent job of identifying how differences in access to health care and treatment affect cost,” she added.
Kellan Baker, Ph.D., executive director and director of learning at the Whitman-Walker Institute, which researches and advocates for health equity with a focus on LGBTQ+ health, also said that Deloitte’s scores seem conservative, though he doubts they are at all. can be calculated exactly. .
The true costs of health inequality are “probably much higher than any estimate due to the complex and interrelated factors that affect health, many of which lie outside health care itself,” he explained.
Deloitte also failed to take into account the social determinants of health, such as housing, education, nutrition, and the physical environment, which have a huge impact on health outcomes and costs.
Rennis pointed out that the main social determinants of health are economic inequalities: “Without addressing the problem of poverty and how it affects the health and well-being of those who live in it, we will never be able to completely eliminate health inequalities or their potential cost to society. . “
The report says that doing the right thing for those underserved by the health care system is not always enough for the big business that forms its backbone. With “health insurance organizations, and we’re seeing this with healthcare systems and even biopharmaceutical organizations, making the right choice is never the easiest because it’s hard to know where the returns come from,” Davis said.
While the report does not provide detailed policy or systemic recommendations for improving equity in health, the actuaries invited stakeholders to consider equity in all business decisions, develop cross-sectoral partnerships, address the social determinants of health, and create a more inclusive workforce, among other strategies.
Hopefully we’ll move from “it’s not just the right thing to do” to “there’s a business imperative behind us,” Davis said.