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Rising costs, aging population threaten Utah's 'healthy state' status

FILE - Sunrise lights the Salt Lake City skyline as a thick blanket of fog covers the Salt Lake Valley on Thursday, Nov. 29, 2018.
FILE - Sunrise lights the Salt Lake City skyline as a thick blanket of fog covers the Salt Lake Valley on Thursday, Nov. 29, 2018.
Steve Griffin, Deseret News

SALT LAKE CITY — Utah is a low-cost, healthy state.

A large population of youth and a long list of healthy behaviors helps to keep it that way. But those factors are changing, taking Utah's reputation along with it.

An aging population, increasing health care needs and changing demographics are making Utah's health care costs grow at one of the fastest rates in the country — maybe enough to derail the health of the populace, or at least lose pace with it, a new report from the University of Utah's Kem C. Gardner Policy Institute states.

The report details issues that may affect the cost and quality of health care in Utah in the coming years and decades. A few of the state's experts on health care gathered Wednesday to discuss it.

"The state is changing, the demographics are changing and those changes are going to require us in health care to pay attention if we're really going to keep our communities and individuals healthy," said Dr. Michael Good, CEO at University of Utah Health, dean at the U.'s medical school and senior vice president of University of Utah Health Sciences.

"I do believe the innovative spirit and culture in Utah will help us figure out the best path forward," he said.

While the population is growing, it is also aging — with the number of people 65 and older expected to double in the next 50 years. Incomes have remained relatively flat in the past decade, with an average 0.4-percent annual growth rate, when insurance premiums and deductibles have increased at three times that, according to the Gardner Business Review's report "Staying Ahead of the Curve: Utah's Future Health Care Needs."

Health care costs are increasing, but so is the number of people using it, especially as Utahns age, the report states. Those increasing costs are compounded when people are faced with multiple chronic conditions or are living in poverty.

More and more Utahns are opting for high-deductible health plans that utilize a health savings account for out-of-pocket costs, but the report indicates that such plans can deter people from seeking proper care when it is needed because it is expensive.

What's more, a national survey found that only 40 percent of people with high-deductible plans actually saved for future health services.

"If you haven't planned for it, if you haven't forecasted an injury, coming up with even $400 for that medical expense can be difficult," said Intermountain Healthcare's senior vice president of community health, Mikelle Moore.

Intermountain, she said, is working to identify ways for routine health care to be more affordable to patients, such as offering a bare-bones labor and delivery service for a flat rate of $2,700. The Salt Lake-based private health system has also set out to manufacture its own commonly used generic medications to lessen the financial burden on patients, while also making the drugs more readily available.

Nate Checketts, director of Medicaid for the Utah Department of Health, said behavioral health is a costly issue, one that the state is trying to streamline for Medicaid patients.

A recent expansion made state and federally funded health care available to about 300 childless adults, mostly homeless men and women who haven't had access to health care for some time. Checketts said that population of enrollees is "super expensive."

Further expansion of Medicaid benefits, Checketts said, would only add to the rising costs of health care in the state. The majority of Medicaid patients in Utah are children, but they account for less than 25 percent of costs.

The latest issue of the Gardner Business Review, compiled by analysts with the U.'s David Eccles School of Business points out that the various demographic issues are occurring at the same time that medical services are getting more expensive.

The health care experts agree that mental health is becoming increasingly more important as it pertains to health care, but is also tricky to properly and effectively deliver.

A person's overall wellness, Good said, is part genetics and partly the medical care they get. However, social and demographic determinants also play a major role, "such as the ZIP code you are born into."

Life expectancies, the report states, are different throughout Utah, depending on the demographics of each county. Environment and personal choices involving diet, tobacco and drug use also play into the health care equation, just like Utah's high suicide and opioid-related death rates, and low child immunization rates.

"These kinds of issues take all of us working together," Moore said, adding that the latest U. report "makes it easier."

"You can leave the house in the morning and deal with the weather once you get outside or you can read the weather report and plan ahead," Good said. "I kind of look at this as our weather report … this is the forecast of what's coming in a very dynamic and changing environment."