Study Finds Fit Seniors Have Fewer Medicare Claims

Older people who stay active may not only keep themselves healthy, they may save the government some money, a study suggests.

The study compared lifestyle practices and Medicare claims of a national survey of 2,921 Americans ages 65 and older. Those who stayed active required the Medicare system to spend substantially less on them, the researchers found.

“To my knowledge, this is the first study that has looked at these activities in terms of Medicare costs,” said Sally C. Stearns, a University of North Carolina, Chapel Hill, researcher who currently is a visiting scholar at the University of Aberdeen, Scotland.

The researchers looked at health care expenses among the men and women who answered questions in the National Survey of Self-Care and Aging, a database on the prevalence of self-care behaviors by noninstitutionalized older adults. Results were published in the October issue of the American Journal of Public Health.

Four years after the respondents answered the survey questions, those who said they gardened had health care expenses that were 19% lower than those who did not report gardening.

Expenses for those who reported swimming or walking were 7% less than those who did not say they swam or walked. Study design problems kept researchers from developing reliable numbers on the dollar amount of savings, Stearns said.

Gardening may be good for the spirit as well as the body, which may account for its benefit, the researchers said. They noted earlier research found that people who gardened and did similar activities were about as likely as people who kept fit to stay alive over a 13-year period.

Fifty-three percent of respondents to the 1990 and 1991 questions said they swam or walked; 47% worked in a garden.

“Overall, the study provides evidence of potential reductions in health care expenditures from simple self-care activities,” Stearns said. And older people should be encouraged to take up such activities, the study said.

Stearns also cautioned that the research only shows an association, not cause and effect. It’s possible that other factors made the more active people less costly to the health care system, although the study did control for health status, Stearns said.

However, the idea that people who stay active can save the government some money on health care fits other research, which found physical activity improves an older person’s health, Stearns said. A future study might try to figure out whether programs that encourage older people to be active would be cost effective, she said. The key question is whether costs of such programs would be less than additional Medicare bills that could result from inactivity.

“The topic is one of the classic ones in health care,” commented David Grembowski, a researcher in health services evaluation at the University of Washington, who was not affiliated with the study. “Does lifestyle choice reduce the cost of care, especially for Medicare?”

Grembowski’s expectation is that it would, at least in the period before the last year or months of life. “Medicare costs are often larger as people get more intensive care,” he said. But there could well be savings before those final days, he said.

The idea that activity can reduce health care costs is appealing, but the study doesn’t prove it, said Joseph P. Newhouse, a professor of health policy and management at Harvard University. “It’s just one more piece of evidence,” he said.

If activity does produce cost savings, however, there would be a large number of Medicare recipients who could benefit, Newhouse said. Although more than one fourth of Medicare money is spent on the 5% of people who are dying, the other 95% “still account for the majority of the dollars,” he said.