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Blowing Smoke About BMI

There’s an interesting report from actuarial consultants Milliman that pours some cold water on the heated debate over State Health Plan costs associated with smokers and people with a high Body Mass Index (BMI). The report, Impact of Height, Weight, and Smoking on Medical Claims Costs, released in April, was an update of Milliman’s Medical Underwriting Guidelines.

Controlling for age and gender, the study found that smokers cost about 9% more than non-smokers. However, when people’s medical histories are known the cost difference is only 5%. The costs associated with BMI are less clear.

The report finds that BMI is not the best way to predict added healthcare costs, even when medical history is known. BMI roughly uses weight divided by height squared and the report finds that weight divided by height cubed (known as Rohrer’s Index) is a better indicator.

Using BMI as a predictor, actual costs are greater for severely underweight and severely overweight people and, for taller people (within a given range of BMI). BMI is also generally criticized because professional athletes can be classified as obese using the measure.

The State Health Plan should be cautious in the use of smoking and BMI criteria for setting premium rates.

4 Comments


  1. Adam Searing

    June 3, 2009 at 2:32 pm

    So, since it costs NC $346/mo in health premiums for each employee, then take a good health history and charge smokers that extra 5% a month (about $17/mo). That’s fair and makes a lot more sense than shoving people into the lowest-rated plans with thousands of dollars more in cost sharing.

  2. Adam Linker

    June 3, 2009 at 2:40 pm

    Or we could just drop the wellness provisions — since state workers are already coughing up plenty of money — and save funds by not paying for worthless drugs and therapies and recouping some of our overpayments to Blue Cross.

  3. EBB

    June 3, 2009 at 7:39 pm

    I go with Adam Linker. Enough research has shown that wellness provisions do not reduce overall health care costs. Early death does.

  4. Pogue Mahone

    June 8, 2009 at 1:22 pm

    Milliman does’t do long term costs, only short term costs. Small Groups average about 3 years with the same carrier. so the carrier is looking for cost project short term, employers would want to look long term.

    But don’t let facts get in the way of a good arguement.

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