Before reviewing your report, it is important to understand the terms it uses.
Total claims = The total cost incurred by your community for health insurance during the period audited.
Lifestyle Related Costs = The sum of all claims with diagnosis codes that have a proven relationship to lifestyle. (In other words, if we found a diagnosis of 162 -- cancer -- we would count the cost of this claim.) Don't be misled! Some of the diseases that have a relationship to lifestyle can also be caused by chance or simply bad luck. You shouldn't expect to reduce your claims by this amount.
Potential Savings = The portion of your lifestyle cost which is most likely caused by unhealthy behaviors. We adjust for the prevalence of health risks in the population, and userisk ratios to determine what portion of each claim could be controlled. (In other words, not every cancer patient smokes. We compute the likelihood that the illness was caused by behavior and the corresponding portion of its cost.) This is the most important number! It's the part of your lifestyle costs that you have a chance of reducing through health risk reduction programs.
Risk ratios = Mathematical formulas, based on medical research, which compute the statistical effect of each lifestyle/behavior health risk on the odds of getting sick, by diagnosis code.
CHART 1
Evansville patients residing in Indiana incurred $414,805,985 for inpatient and outpatient hospital care during the period audited (November, 1993 through October, 1994). Data for this analysis were contributed by St. Mary's Medical Center, Welborn Baptist Hospital and Deaconess Hospital. Claims costs as illustrated above were:
Payor Costs % of Total
| MEDICAID | $38,002,156 | 9% |
| SELF PAY | $13,800,594 | 3% |
| MEDICARE | $192,376,531 | 46% |
| PRIVATE PAY | $170,627,705 | 41% |
| TOTAL | $414,806,985 | 100% |
