Health costs of aging workers imperil state

Study cites trends in population, obesity, medical expenses

By Jeffrey Krasner

An aging workforce, combined with the growing obesity epidemic and the high cost of medical care, could result in an epidemic of preventable illness that might cripple the region's economy, according to a study being released this morning by the New England Health Care Institute and the Boston Foundation.

Wendy Everett , president of the not-for-profit healthcare institute which seeks to improve patient care, said population and cost trends could conspire to make the Boston area the first in the United States to be severely affected by the intersection of demographics and disease. She warned that unless action is taken quickly, within the next eight years companies and municipalities will be hit with rising healthcare costs that make today's annual double-digit increases seem modest by comparison.

"The message of the report is, here we are in paradise, with the best teaching hospitals and physicians and the lowest number of uninsured of any state in the country, and a creative and ambitious health reform program, but if we don't act now our economy is going to be dead in the water," Everett said.

Massachusetts residents have already been coping with hefty annual insurance-premium increases. For the past seven years, premiums have increased an average of 10 percent annually.

But the report highlights some little-noticed population trends that could precipitate a financial crisis.

For instance, its authors say the high cost of living is forcing many residents ages 34 to 44 to leave the state. As a result, the state's workforce is getting older while population growth stagnates. Older workers, and immigrants -- who account for many of the state's new workers -- are more vulnerable to developing chronic illnesses, including obesity, which has led to increases in conditions such as heart disease and high blood pressure. The incidence of adult obesity in Massachusetts doubled from 10 percent 1990 to 20 percent in 2005, according to the Department of Public Health.

"Obesity is the elephant in the room," said Everett. "We are getting fatter and fatter, and that's one of the root causes of chronic illness."

The rise of such preventable conditions will greatly increase treatments costs, driving up healthcare premiums and making it more difficult for local companies to compete with those in less expensive states.

The report also predicts the start of a vicious cycle that could put the Boston area at a greater disadvantage than many other parts of the country: As chronic diseases become more prevalent, state government will have to divert money and other resources from preventive programs to those that treat existing conditions.

"We should view this as a call to action," said Andrew Dreyfus , executive vice president of healthcare services at Blue Cross Blue Shield of Massachusetts, the state's largest health insurer, who has been briefed on the report.

"We need to work now to significantly improve our public health and prevention programs in the state. We need to do a lot in the physician's office, in the workplace, and in the hospital to intervene earlier with people suffering from chronic illness."

Dr. JudyAnn Bigby , secretary of health and human services, downplayed the report's finding, saying some of the apparent increase in chronic disease might be attributable to a rise in the earlier diagnosis of conditions.

"I don't see anything in this report that hasn't been known," she said. "The report makes very clear that Massachusetts is one of the healthiest states in the nation."

The report was funded by the Boston Foundation, a community charity that last year made grants of $70 million to nonprofit organizations. Its title, "The Boston Paradox," refers to the irony that an area with some of the country's top medical research and academic institutions could experience such a serious increase in preventable illness.

Despite the report's grim predictions, Boston now ranks high in measures of public health. For example, in 2004 the life expectancy for someone born in Massachusetts was 79.5 years, well above the US average of 77.9 years, according to the Organisation for Economic Cooperation and Development.

But such statistics are not reason for complacency, according to the report's authors.

"It is now imperative for Greater Boston to become as innovative in public health as we have been in medical technologies," said Paul S. Grogan , chief executive of the Boston Foundation, in an introduction to the report. The foundation is also funding a second study, to be completed in December, that will focus on regulation, legislation, and action strategies that it says could help.

Others involved in state healthcare issues say they are optimistic about finding ways to head off the healthcare problems predicted by the report.

"I don't think this is written in stone yet," said Rick Lord , chief executive of Associated Industries of Massachusetts. "There are opportunities for employers and insurers to prevent this from developing."