Short reportEstimating the costs of medicalization
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Introduction
The percent of the U.S. gross domestic product spent on health care has risen from 4.5% in 1950 to 16% in 2006 (Congressional Budget Office, 2008). Numerous explanations have been offered for this increase including the development and use of medical technology (Rettig, 1994), the aging population (Reinhardt, 2003), and particular reimbursement mechanisms (Bodenheimer, 2005). Critics have suggested medicalization as another potential explanation for increasing health care costs (Budetti, 2008, Hadler, 2008; Szasz, 2007), but to our knowledge no previous studies have systematically tried to estimate the costs of medicalization. In this paper we define medicalization, present a strategy for estimating the cost burden of medicalized conditions, and estimate 2005 US spending on medicalized conditions.
For more than three decades numerous scholars have described the process of medicalization and how an increasing number of conditions has come under medical jurisdiction (Conrad and Schneider, 1992, Zola, 1972). Medicalization is a process by which non-medical problems become defined and treated as medical problems, usually in terms of illnesses or disorders. Examples include menopause, alcoholism, attention deficit hyperactivity disorder (ADHD), post traumatic stress disorder (PTSD), anorexia, infertility, obesity, sleep disorders, erectile dysfunction (ED), among others (14). The growing interest in medicalization is seen in the number of symposiums about medicalization in places such as the British Medical Journal (“Special Issue on Medicalization,” 2007), the President’s Council of Bioethics (Kass, 2003), PLoS (Moynihan & Henry, 2006), and Lancet (Metzl & Herzig, 2007). In both the social science and medical literature, the major focus has been on documenting the rise in medicalization, debating conditions which constitute medicalization, and identifying the implications for patients, medicine and society.
An underlying theme in this literature is the concern about “overmedicalization.” While medicalization describes a social process, like globalization or secularization, it does not imply that a change is good or bad. Some observers have raised the concerns that medicalization is an over-expansion of medicine’s professional jurisdiction and is a mechanism by which the pharmaceutical industry can increase markets, thus contributing to rising health care costs (Moynihan & Cassels, 2005). While these issues have been raised repeatedly, to our knowledge, no analysis of medicalization has attempted to estimate the fiscal impact on health care spending. Recognizing that there are many difficulties in such a task, not the least of which is defining what conditions are forms of medicalization, we believe such an estimate would be an important addition to the literature. While it is clear that in the last three decades there has been a significant growth in the number of medicalized conditions as well as number of patients treated for those conditions (Conrad, 2007), we seek to address what contribution this trend has had on the societal problem of spiraling health care costs.
Section snippets
Identifying medicalized conditions
A key issue in this study was to identify medicalized conditions. Selection of ‘medicalized conditions’ was based on two criteria: 1) a published study identified the condition as an example of medicalization since 1950 (Ballard and Elston, 2005, Barsky and Boros, 1995, Conrad, 1992, Conrad, 2007) and 2) the availability of reasonably valid and current data on US national medical expenditures for that condition. In the end, we included 12 conditions (see Table 1). Schizophrenia and bipolar
Results
Our estimate of the total direct health care costs in 2005 attributable to the twelve medicalized conditions was $77.1 billion. This is 3.9% of the $1.97 trillion in total national health spending for the United States in 2005 (Catlin, Cowan, Heffler, & Washington, 2007).
The two types of conditions that together make up almost half of these expenditures are uncomplicated pregnancy and body image services. Together the size of this bill is substantial, generating a notable cost to the private
Discussion and implications
There have been concerns that medicalization has been a major driver of increased health care costs in the United States. We estimate that the medicalized conditions we could identify make up $77.1 billion in annual health care spending. This is a relatively minor portion of national health care expenditures (<4%) and therefore medicalization is unlikely to be a key driver of spiraling health care costs. Yet, $77.1 billion represents a substantial dollar sum. In comparison, $56.7 billion was
Acknowledgements
Our thanks to the reviewers and editor for comments on an earlier draft of this paper.
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