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Supplements Prescription Drug Copays and Their Effect on Vulnerable Populations

Vulnerable Populations: Who Are They?

Employers and Chronic Healthcare Coverage
Employees with chronic health conditions, or those with a close family member with 1 or more chronic conditions, put tremendous strain on employers, with the impact extending beyond direct medical costs. In comparison to the general population, decreased productivity resulting from required absenteeism to care for those with chronic conditions is a direct cost to employers. As seen in the Table, the chronically ill are twice as likely as those in the general population to report poor health days. Nearly 1 of 4 patients with coronary artery disease report 20 or more of these poor health days, as do 22% of patients with diabetes and 21% of patients with depression.2 This affects employer costs related to absenteeism.

It also affects employer costs related to presenteeism, which is defined as the impact of a health condition on work performance.16 For example, someone with depression may go to work, but accomplishes little because of their illness. There is some evidence that presenteeism may be underreported and may represent a larger percentage of overall indirect workplace costs for medical conditions than previously thought.17

Collins et al, who conducted an online health survey of 7797 Dow Chemical workers between July and September 2002, found that although absenteeism during the 4-week recall period varied by chronic condition from 0.9 to 5.9 hours, work impairment varied from a 17.8% to a 36.4% reduction in ability to function. The greatest number of absences and work impairments came from those reporting depression, anxiety, or emotional disorders (36.4%) or breathing disorders (23.8%). Additionally, the more chronic conditions, the greater the number of absences and level of work impairment.16

The costs for presenteeism are now considered the largest component of employer costs for chronic conditions, even larger than for direct medical costs. For example, on average (2002 dollars), researchers estimated that presenteeism cost Dow Chemical $6721 per employee, or 6.8% of its total labor costs across its entire US workforce.16

Vulnerable populations, defined as those at greater risk for poor health status and healthcare access, experience significant disparities in life expectancy, access to and use of healthcare services, morbidity, and mortality. Their health needs are complex, intersecting with social and economic conditions they experience. This population is also likely to have 1 or more physical and/or mental health conditions.

As many patients grapple with chronic illnesses, they not only cost private and public health insurers a disproportionate amount of healthcare dollars, but they also impact employers through increased absenteeism and presenteeism rates. The number of patients with chronic conditions is expected to rise by 37% within the next 24 years,12 placing significant strain on existing healthcare systems, particularly as the condition of this population is exacerbated by existing social and economic risk factors.

1. National Center for Health Statistics. Health, United States 2005. Washington, DC: US Department of Health and Human Services; 2005. Available at: d/hus/state.htm. Accessed August 2, 2006.

2. Robert Wood Johnson Foundation. A portrait of the chronically ill in America, 2001. Available at: iles/publications/other/ChronicIllnessChartbook2001.pdf. Accessed August 2, 2006.

3. Agency for Healthcare Research and Quality. Healthcare disparities in rural areas: selected findings from the 2004 national healthcare disparities report. Available at: ldispar.htm. Accessed August 4, 2006.

4. Aday LA. Who are the vulnerable? In: At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States. 2nd ed. San Francisco, Calif: Jossey-Bass; 1991:1-15.

5. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: US Department of Health and Human Services; 2000. Available at: Accessed August 2, 2006.

6. Satcher D. Eliminating racial and ethnic disparities in health: the role of the ten leading health indicators. J Natl Med Assoc. 2000;92:315-318.

7. Keppel KG, Pearcy JN, Wagener DK. Trends in racial and ethnic-specific rates for the health status indicators: United States, 1990-1998. Healthy People 2000 Stat Notes. 2002;23:1-16.

8. Institute of Medicine, Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.

9. Partnership for Solutions. Chronic conditions: making the case for ongoing care. Johns Hopkins University: December 2002. Available at:
. Accessed August 2, 2006.

10. Kaiser Family Foundation. Number of uninsured Americans is growing. Available at: heet.pdf. Accessed September 3, 2006.

11. Reed MC. An update on Americans’ access to prescription drugs. Issue Brief Cent Stud Health Syst Change. 2005:1-4.

12. Wu SY, Green A. Projection of chronic illness prevalence and cost inflation. Washington, DC: RAND Health; 2000.

13. Shi L, Stevens GD. Vulnerability and unmet health care needs. The influence of multiple risk factors. J Gen Intern Med. 2005;20:148-154.

14. Hoffman C, Rice D. Chronic care in America: a 21st century challenge. Princeton, NJ: The Institute for Health and Aging, University of California, San Francisco for The Robert Wood Johnson Foundation; 1996.

15. Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Aff (Millwood). 2001;20:267-278.

16. Collins JJ, Baase CM, Sharda CE, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005;47:547-557.

17. Burton WN, Pransky G, Conti DJ, Chen CY, Edington DW. The association of medical conditions and presenteeism. J Occup Environ Med. 2004;46(6 suppl):S38-S45.

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