Sydney Morning Herald - Thursday 2 March, 2006

Obesity bill more than health budget

By Ruth Pollard
Health Reporter

THE cost to Australia of providing health care for people who are obese, overweight and physically inactive, combined with the expense to employers of lost work days, has grown to $10.8 billion - a little more than the NSW health budget.

Without immediate federal government action of incentives via Medicare, the burden of the disease will continue to spiral, said the director of the Institute of Health Economics and Technology Assessment, Paul Gross.

Private health funds also have a role, by following the lead of funds in the US and Britain that provide incentives for members to stay fit, Mr Gross said.

Expenditure on overweight and physically inactive people made up 6 per cent of the health budget, while the indirect costs such as lost productivity were at least double that, he said.

For every percentage point rise in body mass index - a measure of a person's height-to-weight ratio - national healthcare expenditure will rise by 2.3 per cent, he predicted. "I estimate the costs of obesity in lost work days and lost productivity were 2.5 times the direct costs," Mr Gross said.

His predictions follow this week's release of Australian Bureau of Statistics data that shows the proportion of overweight or obese adults rose from 44 per cent to 53 per cent in the past 10 years.

The lack of incentives in either publicly funded health programs or via private health insurance had created a real barrier to people being able to access appropriate weight loss programs, he said.

"GPs have to be paid to do integrated obesity management - looking at all aspects of life: lifestyle, exercise and food intake. That requires the Government to set a fee on the Medicare Benefits Schedule for weight-loss management," he said.

A spokeswoman for the Health Minister, Tony Abbott, said the Government already provided incentives for doctors to better manage overweight and obese people through care plans.

"The Government supports measures that encourage healthy lifestyles and is currently considering changes to private health insurance that promote wellness and prevention," she said.

Tim Gill, of the Australasian Society for the Study of Obesity, said there was an immediate need to intervene.

The Government could offer rebates for services by exercise physiologists and dieticians to ensure health care was provided in multidisciplinary teams and not just by GPs.

"Incentives could also be offered to employers to create opportunities for employees to undertake programs such as tax breaks or reduced workers comp premiums," Dr Gill said.

March 2, 2006
While most health dollars are spent on acute care, experts argue the money could be better used for prevention, writes Ruth Pollard.

IF WE are not, as the poet John Milton wrote, to "live a life half dead", how do we judge what a life is worth and how much should be spent to preserve it? As governments wring their hands over the spiralling cost of health care - now running at twice the rate of economic growth - the obvious but long-term brake that could be applied is the creation of a healthier population.

Chronic disease accounts for almost three-quarters of all health expenditure and that, along with the impact of ill health on labour force productivity, increases the real cost of poor health, at a personal and an economic level.

The bulk of health expenditure continues to be directed at the acute end of the health system, treating people after they get sick with expensive pharmaceuticals and diagnostic technology, rather than preventing the illness from occurring - or at least delaying its onset.

"We spend 2 to 3 per cent of our budget on 40 to 50 per cent of the disease burden, which is preventable," says Dr Rob Moodie, the chief executive officer of VicHealth, the Victorian Health Promotion Foundation.

A classic example is the anti-smoking drug Zyban. When it first became available through the Pharmaceutical Benefits Scheme in 2000, Australia spent $83 million in one year with a very limited effect, Moodie says. A 2002 study found that while 10 per cent of smokers had tried Zyban since 2000, 80 per cent of people did not complete a full course of treatment.

Moodie argues the money could have been better spent - for example $10 million was invested in anti-smoking programs in 2000, resulting in 190,000 people quitting and saving 1000 people from dying, he says. "Why is the system so skewed that money pours out to pharmaceutical interventions and not much to public health interventions that can reduce the disease burden?"

Health economists have worked out to the dollar what a life is worth. The answer? In Australia, $3.7 million, or $162,561 a year, says Lynne Pezzullo, a senior health analyst and associate director of Access Economics.

Taking into account factors such as what people are prepared to trade off for money - working in a risky profession or paying to install a smoke alarm, for example - along with potential earnings and other measures, the value of a life is an important figure to consider when working out how much to spend saving it.

Added to that, the World Health Organisation has developed a standard for the amount of money governments should reasonably spend to gain one year of life, a "quality-adjusted life year", or QALY. In Australia it is a minimum of $40,000.

Quick steps to outrun an accelerating illness

March 2, 2006

FOR those watching the development of human disease, it is the pace at which diabetes is growing that causes the most anxiety.

Type 2 diabetes - caused mainly by diet and other lifestyle factors - is costing an average of $11,000 a person a year, or a $3 billion yearly burden on the Australian economy.

Alarmingly, 7.4 per cent of Australians over 25 have type 2 diabetes, but only half of them know about it. A further 16 per cent have markers in their blood that indicate impaired glucose tolerance, a pre-diabetes condition, according to the Australian Diabetes Prevalence Study.

But two major disease prevention studies - one in Finland and one in the United States - have shown that even small changes in diet and exercise can significantly delay or prevent type 2 diabetes.

Researchers asked people who were obese and had pre-diabetes to modify their lifestyle by doing 30 minutes of moderate exercise a day and changing their diet.

The Finnish participants reduced their weight by 5 per cent, or four to seven kilograms, and in doing so, reduced their risk of developing diabetes by 58 per cent compared to the control group.

Similar results were produced in the US study, which also measured drug interventions. It found that lifestyle changes were twice as effective as pharmacological treatments in preventing diabetes.

Not only were the results sustained over years, but the benefits were realised almost from the moment people began regular exercise - putting paid to the argument that public health interventions produced benefits only in the long term.

The study on the cost of diabetes, run by Stephen Colagiuri, the director of Diabetes Services at Prince of Wales Hospital in Randwick, found that most costs were associated with complications from the disease resulting in hospitalisation or drug treatment.

The average costs per person were $5360 plus $5540 in benefits, such as pensions and sickness benefits from the government.

The cost per person more than doubled when complications such as foot/leg ulcers, eye problems, kidney problems and amputation, heart disease and stroke occurred.

The average age of those surveyed was 65 - most were retired, so there was little cost regarding lost productivity.

There is no doubt, Colagiuri says, that those costs will rise by at least 50 per cent if a person is working, which is where the diabetes epidemic is heading.

"We have done some modelling for screening for undiagnosed diabetes and then introduced treatment - it would become cost-saving after about seven years," he says.

Ruth Pollard

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