By Robert Herron
The Independent Effect of Selected Health Risk Factors on Medical Costs
(In 1996 U.S. Dollars)
In general, those who have served in our Armed Forces, especially in combat, have been exposed to more intense and prolonged stress than the general population. As shown in the previous chart, chronic stress is a leading driver of high medical expenses (1). Anderson and colleagues compared the impact of various health risk factors on medical expenses. They reported: “Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures (1).”
These risk factors were statistically adjusted to be independent of all other risk categories. In the real world, high stress would contribute to most of these risk factors, but in this study each of these categories have been adjusted to show their sole, individual contribution to medical expenses without the influence of other variables (1). The conclusion seems to be that the prolonged exposure to excessive stress, which is inescapable in military life, is one of the greatest contributors to high and rising medical expenses.
Consistent high-cost people have long-term poor health due to several chronic conditions, which are affected by excessive stress. Chronic stress weakens the immune system, which increases vulnerability to most diseases. Stress also degrades most other physiological systems. Chronic stress causes, aggravates, or contributes to a wide range of physical and mental disorders. Prolonged stress also contributes to the unhealthy lifestyles that cause most chronic conditions, which account for approximately 80% of national medical expenditures. Furthermore, chronic stress also contributes to rising suicide rates.
A study conducted at the Health Economic Resources Center found that in Fiscal Year (FY) 1999:
35% (1.2 million) of VA health care users had 3 or more of the 29 chronic conditions. These individuals accounted for 73 percent of total cost. Overall, VA health care users have more chronic diseases than the general population (2).
Another study found that in 2008 approximately 22% of VA patients had four or more chronic conditions (3). This relatively small group of 22% of VA health care users with multiple chronic diseases incurred the majority of VA medical treatment costs. In addition, Yoon et al. found that the percentage of VA patients with 4 or more chronic conditions has been increasing; it grew from 15% in 2000 to 22% in 2008 (3). This concentration of medical expenditures is typical in most populations. For instance, the highest spending 10% in the general U.S. population incurred 60% to 70% of total medical expenses annually. How could stress reduction with the TM technique help?
The largest and quickest reductions in medical costs could be achieved by providing the TM program to consistent high-cost veterans with multiple chronic diseases. The following chart shows a 28% reduction in doctors’ bills over five years from baseline for persistent high-cost people who practiced the TM technique (4).
If the VA provided the TM technique to the veterans who consistently incur high medical costs, billions of dollars could be saved for other important priorities. TM practice can help veterans in many other health-related areas.
The Health Economic Resources Center also found that among VA health care users in 2008, the most common chronic disease was hypertension, which afflicted 1,761,150 people, or 36 percent of VA patients (3).
Comparative research has found that the TM technique is more cost-effective (5) in reducing high blood pressure than costly anti-hypertension drugs that often have negative side effects of (5–13).
The control of hypertension is important because high blood pressure is a major risk for cardiovascular disease, the number one cause of death in the United States. The number of VA patients with heart conditions increased from 455,361 in 2000 to 646,991 in 2008 (3). TM practice improves all aspects of cardiovascular health.
Growth in VA Expenditures for Treating Heart Diseases
Numerous studies published in peer-reviewed scientific journals suggest that TM practice will have a very beneficial effect in reducing heart diseases in VA patients. The following list and related citations summarize the research that documents the effects of the TM technique in improving various aspects of cardiovascular health.
A recent study on coronary heart disease (CHD) found “the Transcendental Meditation program, significantly reduced risk for mortality, myocardial infarction and stroke in CHD patients. These changes were associated with lower BP and psychosocial stress factors (22).” Thus, the TM technique is a valuable adjunctive therapy for the treatment and prevention of heart conditions.
The average age of VA patients with three or more chronic conditions was 62 years in FY1999 (2), and in 2008 47% of VA health care users were age 65 or older (3). A study in Canada compared the payments to physicians of 163 people over age 65, who practiced the TM technique, with 163 matched seniors who did not meditate. After starting TM practice, payments were significantly reduced in the TM group compared with controls, with a five year cumulative reduction of 70% (23).
Over 240 articles have been published in peer-reviewed scientific journals showing that the TM technique improves mental and physical health. Many of these studies were randomized clinical trials and meta-analyses. Several randomized clinical trials were funded by the National Institutes of Health to examine the impact of TM practice on cardiovascular health.
The distinctive stress-reducing and health-enhancing properties of TM practice have major policy implications. When considering all of the published research on the benefits of TM practice for mental and physical health, it is clear that if the TM program was provided to consistent high-cost veterans, then it would be possible to leverage great reductions in VA health care expenditures. Why not provide the TM program as soon as possible?
Robert E. Herron is an independent researcher, writer, speaker, and consultant in medical cost reduction and health policy. He earned a B.A. in English in 1975, an MBA in 1985, and doctoral degree in management in 1993 at Maharishi University of Management. From 1996 to 1998, he completed a post-doctoral program in the epidemiology of cardiovascular disease that was funded by the National Institutes of Health. Herron has taught a wide range of business and government policy courses at the undergraduate and graduate levels. He has conducted research to evaluate the cost-effectiveness of various methods of disease prevention and alternative medicine.
Dr. Herron has been practicing the Transcendental Meditation (TM) technique for many years and became a TM teacher. He was also a combat veteran who served in the U.S. Marine Corps and feels that TM practice saved his life.
Dr. Herron’s book New Knowledge For New Results reveals a comprehensive strategy to reduce high and rising medical costs. It provides a simpler and more complete understanding of how complex medical systems work than past efforts. While others provide partial, superficial solutions, which focus mainly on financial issues, this book reexamines the underlying foundations of modern medicine. Faulty knowledge misguides the medical system to perform inefficiently and expensively, in spite of the best efforts of sincere, dedicated, and competent health-care professionals.
The book presents numerous winning solutions for improving medical system effectiveness. These include a complete science-based plan that applies disease prevention, health promotion, public health, primary care, scientifically verified complementary and alternative medicine, and many other approaches to improve health and reduce medical expenses. While this innovative book contains many science-based solutions, it is simple, clear, and easy to understand.
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2. Yu W, Ravelo A, Wagner TH, et al. Prevalence and costs of chronic conditions in the VA health care system. Medical Care Research and Review 2003; 60(3) Supplement to Sept. 2003: 146S–167S.
3. Yoon J, Scott JY, Phibbs CS, Wagner TH. Recent trends in Veterans Affairs chronic condition spending. Population Health Management 2011; 14(6): 293–298.
4. Herron RE. Changes in physician costs among high cost Transcendental Meditation practitioners compared with high cost non-practitioners over 5 years. American Journal of Health Promotion 2011; 26(1): 56–60.
5. Herron, RE, Schneider, RH, Mandarino, JV, et al. Cost-effective hypertension management: Comparison of drug therapies with an alternative program. American Journal of Managed Care 1996; Vol. II(4): 427–437.
6. Wallace RK, Silver J, Mills P, Dillbeck MC, Wagoner D. Systolic blood pressure and longterm practice of the Transcendental Meditation and TM-Sidhi program: Effects of TM on systolic blood pressure. Psychosomatic Medicine. 1983;45(1):41–46.
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18. Castillo-Richmond A, Schneider RH, Alexander CN, et al. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke. 2000;31:568–573. 19. Zamarra JW, Schneider RH, Besseghini I, Robinson DK, Salerno JW. Usefulness of the Transcendental Meditation program in the treatment of patients with coronary artery disease. American Journal of Cardiology. 1996;77:867–870.
20. Barnes VA, Treiber FA, Turner R, Davis H, Strong WB. Acute effects of Transcendental Meditation on hemodynamic functioning in middle-aged adults. Psychosomatic Medicine. 1999;61:525–531.
21. Alexander CN, Barnes VA, Schneider RH, et al. A randomized controlled trial of stress reduction on cardiovascular and all-cause mortality in the elderly: Results of 8 and 15 year follow-ups. Circulation (abstract). 1996;93(3):19.
22. Schneider RH, Grim CE, Rainforth MV, et al. Stress reduction in the secondary prevention of cardiovascular disease: A randomized controlled trial of Transcendental Meditation and Health Education in African Americans (In press).
23. Herron RE, Cavanaugh K. Can the Transcendental Meditation program reduce medical expenditures of older people? A longitudinal medical cost minimization study in Canada. Journal of Social Behavior and Personality 2005; 17:415–442.