Monthly Healthcare Insights: Heart disease, healthcare costs

Too, American Heart Association predicting raised incidence of cardiovascular diseases and costs 
In order to estimate the possible share of cardiovascular disease in the next quarter turn of the century, the American Heart Association (AHA) has relied on the National Health and Nutrition Examination (NHANES) survey data set. The headline, therefore, is that the prevalence of obesity and high blood pressure will raise the incidence of cardiovascular diseases, and overall cost of cardiovascular diseases will triple over the given period. 
 
First the good news. The projections from the AHA show that the prevalence of the trend of adult behavior that enhances the hazard of heart disease will generally enhance during this time periods. None will smoke, none will have poor diets, and increased will exercise. Some will have raised cholesterol levels because of poor management; however, fewer will have high cholesterol levels because treatment has improved. Still, few will find sleep easy and a good night’s sleep is linked to a reduced risk of CVD. 
 
But wait, this has worse news. Hypertension prevalence increased from 50% for adults as of 2020 and this study estimated it to be 61% for adults by 2050. Presently, 16. 3% of adults have diabetes; this will rise to 26. 8% of adults within this decade. While the growth in the rate of cardiovascular disease admits a higher number of elderly persons, most of it may be attributed to the growth in risk factors such as obesity, hypertension and diabetes. 
 
For this purpose, another set of researchers used these projections to estimate the cost of cardiovascular disease. I think the researchers have applied inflation-adjusted dollars to study, so the rise in the disease and utilization are responsible for it rather than the rise in prices annually. 
 
Some crucial figures include much of the rise in medical costs have been precipitated by those in the over 65-age bracket with Medicare covering all the costs. For cardiovascular diseases among the commercial population, there is a significant loss in actual production, in addition to higher costs incurred in treating the diseases. 
 
Trends in behavioral risk factors for premature heart disease are summarised to be coming down with the exception of obesity and aging population which are on the rise. Despite the availability and accessibility of effective treatments, patients with higher rates of CVD will incur higher medical expenses and face more time off work. 
 
Implications for employers: 
 
Improvement in the management of obesity can go a long way in helping. However, the current cost of use means that the consumption of GLP-1 medications will be rather restricted. Minimizing costs of related other anti-obesity drugs can also be exercised by employers. 

The most worrisome of these changes is the rise in hypertension and contrary to what people think, effective management of hypertension is relatively cheap. Preliminary information is that the control of hypertension is a regular HEDIS reporting measure, and employers can request from their carriers reporting on this indicator at a given time. 
Employers can make first and second-line anti-hypertensives the cheapest to enable the reduction of any cost hitches associated with these useful drugs. This may assist in fixing the reality that among commercially-insured people with acknowledged cardiovascular illness, only 55 per cent had good management by 2022. This way, employers can increase their employees’ awareness of hypertension dangers and integrate movement and exercise wellbeing programs with the anti-hypertensive campaign. 

Hypertension and heart risks can be enhanced by stress’s decrease. Stress management and resiliency programs are accessible through member EAP or well being programs which can be highlighted by employers. 
It was forecasted that the expenditures on National health insurance are going to rise. 
The future spending of Medicare, Medicaid and other public and private insurance plans was made and released by the Office of the Actuary of the Centers for Medicare and Medicaid Services (CMS) in the magazine Health Affairs. They predicted that medical costs will go up to $7. has projected that global health spending will reach 7 trillion by 2023, 19. Earlier reading indicated that the total level of health manpower costs does 7% of gross domestic product. This is expected to extend mainly on the basis of medical inflation which has been brightening overall inflation and growth of the economy. : Some of this increase is because we are living longer; however, the lion share of it is due to the faster growth of the prices of health care. 
 
The Office of the Actuary projected that a traditional private health insurance member cost would rise from 6,838 US$ in 2023 and reach 10,576 US$ in 2032. Majority of the privately insured people are those under employer sponsored health plans although this category also includes those who have purchased health insurance on the marketplaces. The researchers estimated that health insurance that is offered through the employees would rise to 2. 5 million people in 2026 as the marketplace subsidies from the Inflation Reduction Act end; however, lower birth rates and the retirement of the last cohort of baby boomers reduce the numbers to 4. Employer sponsored health insurance will be 3 million lower in 2032 as compared to 2024. 
 
Implications for employers: 
 
Aim at achieving affordable health care cost both for a company’s employees and the business itself will prove more and more hard in the proceeding years bearing in mind that, although it is assumed that health care inflation is steadily rising and projected to rise beyond the general inflation. 

Employer-sponsored health insurance is expected to decrease in the coming years because demographic shifts expected to result in shortages of skilled employees are likely to increase employees’ wages and push for better benefits. 
The paper indicates that the United States is one of the worst places to be a mother and receives poor ranking in regard to maternity care. 
The findings of the maternity care in the United States of America and 13 other developed countries were released by the Commonwealth Fund. These are the expectable numbers of maternal mortality and remain exceptionally poor especially for Black U. S. moms. The researchers reveal the fact concerning the case fatality within the postnatal period of up to a year after childbirth, claiming it is 65 per cent of maternal mortality. They add that the U. S is somewhat different from these other countries in the following ways. 
 
The Ranking and the Supply of midwives and Obstetricians in U. S. Besides, the proportion of midwife provider in many better-performing countries is significantly higher compared with obstetricians while (U. S) has only one-third of the delivery care provider as midwives. 
They were dissatisfied by the fact that maternity care opportunities are scarce in the vicinity of one’s home. There are 6. 9 million women of childbearing age in the U. S. that reside in counties that have no obstetrical providers and no facilities for childbirth. 

The United States of America does not legislate for Parental or Maternity/Maternity leave. 
Current practice reveals that cost for maternal health in the U. S. remains high whereas approximately eight million women in the group of reproductive age lack health insurance. When it comes to out of pocket expenses women’s employer sponsored health insurance kept exceeding $4,500 in 2015, out of pocket costs by gender. 

The Commonwealth Fund does not make a big deal of this, but partially mental health problems contribute to near one-quarter of postpartum deaths in the United States.

Implications for employers: 
 
An insurance plan with reasonable premium can be provided by the employers, if those with children cannot afford high deductible, then options should be availed.  Employers can provide comprehensive mental health care plans and demand that their plan’s carriers provide plan networks that are sufficient. 

Parental leave must be provided by the employer in order to minimize the pressure of stress, financial and otherwise that new parents are subjected to. 
Other employer sponsored programs like virtual advocacy programs and digital monitoring programs in hypertension, gestational diabetes and premature labour can also be useful. 
Likewise, round-the-clock professional triage for anxiety and depression can assist the lost persons in identifying places to seek mental health services. 
Obesity epidemic is not due to increased food intake and/or decreased physical activity 

Most people believe that this is due to Americans consuming more calories and ‘sitting on their behinds’ more frequently. However, there is some pretty solid proof showing that this just isn’t the case. 
 
I was recently on a panel in Cleveland with Robert Lustig a pediatric endocrinologist, emeritus UCSF professor. He’s the author of several books, including Obesity Before Birth Maternal and Prenatal Influences on the Offspring (2010) and Fat Chance: In this documentary Sugar Coated (2012) and Sugar and Spice and Everything Nice (2011) are incorporated with documentary Beat the Odds (2013). 
 
He presented some figures regarding the amount of calories consumed – and it has remained practically the same for the last twenty years or so, and yet, the issue of obesity has grown far worse. 
 
He also pointed out that there is an upgrade in the level of physical activity exhibited among Americans. The proportion of the American population that exercises sufficiently according to recommendations has increased in the past twenty-five years. Guidelines on physical activity suggest that a person should engage in moderate intensity physical activity for 150-300 minutes per week or engage in 75- 150 minutes per week of vigorous intensity physical activity. 
 
Thus, what has resulted in the rise of obesity in the U. S. , as well as in the global community? 
 
Of course, there are some food items that will take longer to digest and will also take longer for the ‘glycemic index’ Hence, carbs, particular the refined ones, produce more insulin and thus more weight gain than if one ate proteins or fats. That is why very low carbohydrate containing diets (like ketogenic diets) prove to be efficient in the process of weight loss. 
 
It can be seen that Lustig concentrates on ultra-processed foods and obesogens. High glycemic foods are obtained from highly processed foods because they increase the secretion of insulin and fat content. Instead of whole grain oatmeal we consume hyperpalatable sugar coated breakfast cereals to give it an example. 
 
Obesogens are a broad group of invented chemicals causing obesity even in the lack of high calorie consumption. These are such products as plastics and pesticides. It is used in the manufacturing of food items’ covers and personal hygiene products. Levin lists this category as ‘‘forever chemicals’’ that have been used in nonstick cookware and stain-resistant fabrics. Some are “ endocrine disruptors” that alter the metabolism of people leading to weight addition. Bisphenol A exposure for example; maternal, pre-natal and early childhood exposure is related to obesity in later life. PFAS or perfluorinated alkylate substance known as the forever chemical, clinical investigations have demonstrated that patients with higher blood concentrations of this chemical regain more weight as compared to patients with less blood concentration when they stop dieting. 
 
Implications for employers: 
 
Obesity has various origins and once a person develops overweight in childhood and sometimes even before birth, the individual becomes a candidate for obesity in adulthood. 
The obesogen hypothesis makes one once more think about obesity’s complexity cannot be resolved simply by telling a person holding high BMI to eat less. 
Those employers who have cafeterias at the workplace, should ensure that they serve; food that has not undergone severe processing, food that does not contain additives that may be harmful to the employee’s health. 
Companies can wait for legislation to reduce the workers’ exposure levels to obesogens in the workplaces. 
As mentioned earlier, BMI is an inaccurate measure that does not reflect the body composition properly; but there are hardly any better real-life measures available on the most natural way of facilitating people’s dealings with their bodies. 

The popular method of Body Mass Index (BMI) that is applied to evaluate underweight, normal weight, overweight, and obesity status of a population was not intended for clinical decision making. Of them, metabolic obesity is only moderately associated with this measure. However, the treatment cannot boast great practical equivalents. 
 
In the first place, BMI was invented by a Belgian mathematician in the search for a tool to measure obesity relating to whole population not to pass judgements on people. But the measure does exclude waist size, and, as is common knowledge, the risk isn’t as much obesity in the hips but that around the abs. That is partly because it isn’t adjusted for age. Professional bodybuilders are classified as obese even when they have lots of muscle mass; Asians may be normal weight obese and have terrible metabolic profiles. They found that if people had normal weight for height but higher body fat specifically around the waist they faced higher mortality. Last year, the American Medical Association advised on the matter that the usefulness of the BMI should be downplayed. 
 
An ideal measurement to point to obesity should be, to some extent, reflective of if an individual has fats in and around the organs. This is the type of fat which enormously elevates the probability of diabetes and cardiovascular, kidney and liver illness. 
 
Yes, there are other measures to BMI but they all possess some drawback. None can be assessed remotely, and many require highly trained examiners or expensive equipment:None can be assessed remotely, and many require highly trained examiners or expensive equipment: 
 
WC evaluates abdominal obesity which is a predictor of cardiovascular diseases and early mortality. There is a high variation among different observers, but this is one of the most popular indicators. 
The Waist hip ratio is the WHO recommended to use in determining obesity. Once more, the level of the discrepancy between raters is high. 

Skinfold thickness employs a caliper to guess a individual’s body fat makeup. This metric seems to call for a talented tester and there aren’t many caliper makers in the market. 
Bioelectrical impedance, as the name suggests, passed a very small current through the body to determine the % body fat. This has the need for specialists equipment and professionals. 
Factors of assessment and Body composition can be measured with DEXA scan, which stands for dual-energy X-ray absorptiometry, and it operates on low dosages of radiation. It involves a small level of radiation exposure, and this needs gears and a personnel trained in handling radiation. 

Hydrostatic weighing uses fluid to estimate the body density, whereby the body is submerged into the fluid. This and air displacement are only done in research laboratories. 
like; Fluid submersion and estimates body density ; body fat percentage Air displacement plethysmography; 
3D body scanners rely on lasers and cameras in scanning for a 3-D representation of the body. It remains to be noted that this is a relatively new technology and the products containing this technology are not easy to get. 
Implications for employers: 
 
Thus, body mass index appears to be with us to stay as the measure of obesity. Only a very small amount of skill training, and no specialized equipment is needed to measure it and it is cheap and easy to calculate. 
Thus, employers should realize that BMI is definitely not the final on whether one becomes prone to other cardiometabolic risks. 

Some with a significant amount of central obesity or large waistline could be prescribed anti Obesity medicines even if their BMI is within the normal range.  Persons with large muscles, for instance those involved in activities that require building muscularity, may have large BMIs showing them to be obese and their obesity will not reduce even with weight loss.
 
Many of those treated with GLP-1 would now be likely to be metabolically unhealthy so, consequently, would get the most benefit from these expensive drugs if such prescriptions were limited to persons with a BMI of over 30 (27 for those with a metabolic comorbidity). But, if employers were to take a different cutoff for drug eligibility, then they would lose significant rebates pertaining to such medications.