In addition to contributing to major health problems, failing to meet federal clean air standards is expensive, a new study shows.
From 2005 to 2007, California hospitals were paid $193 million for nearly 30,000 admissions and emergency room visits due to illnesses caused by exposure to excessive levels of ozone and particulate pollution in areas for the state that were out of compliance with federal clean air standards, according to a new RAND Research study, paid for by the William and Flora Hewlett Foundation and the Kresge Foundation. And those numbers don't include other medical costs, such as doctors' visits for chronic problems such as asthma and lung disease caused by dirty air.
Los Angeles county, famous for its struggles to curb pollution, saw the highest expenses, with almost $83 million spent on hospital costs.
Just like preventing obesity to reduce diabetes and heart disease, preventing air pollution saves lives — and money for the federal and state governments, insurance companies and residents. And in this case, prevention is simple: California needs to adhere to existing federal clean air standards throughout the state and clean up non-attainment areas — those areas where federal clean air standards are not being met.
According to Dr. John Romley, lead author of the study, premature mortality accounts for about 90 percent of those costs. Non-compliance is literally killing Californians.
Medicare covers the bulk of the costs of hospitalizations and emergency room visits due to dirty air, over $100 million. Private insurers pay close to $56 million, and Medi-Cal covers the rest. Of the private insurers, Kaiser Foundation Health Plan saw almost $87 million in hospital charges due to illnesses caused by air pollution over the three-year period (this was the list price for services, not the actual discounted price paid by the insurance companies, which the $193 million figure is based on).
Romley believes that these levels of spending may create natural allies in the effort to regulate air quality.
"Stakeholders are spending for medical care on a consistent and predictable basis and should have a voice in air quality," Romley said on a conference call discussing the results of the study.
"Linked to health reform is the issue of addressing spending and costs. There may be opportunities in other policy domains to make some progress in reducing health care costs while improving the health of Californians through regulating air quality."
Researchers used records from air pollution agencies and hospitals to estimate how failing to meet federal and state standards for particulate matter and ozone affected private and public insurer spending for hospital admissions for respiratory and cardiovascular causes, and emergency room visits for asthma throughout California from 2005 to 2007. The most common ailment due to elevated air pollution levels was asthma among children ages 17 and under. During the period studied, there were more than 12,000 hospital visits due to asthma.
Most costly were hospitalizations due to acute bronchitis, pneumonia and pulmonary disease caused by air pollution. These events accounted for almost one-third of the total costs. The majority of illnesses, nearly three-quarters, were linked to high levels of particulate matter, tiny pieces of soot that can get lodged in the lungs causing respiratory disease.
Hospitalizations were concentrated in the San Joaquin Valley and the four-county South Coast Air Basin, and many occurred in low-income areas near industrial polluters and ports. RAND has created an online mapping tool to assess hospitalizations and spending by congressional district. The research group intends to do a follow up study focusing on the environmental justice issues of poor air quality leading to hospital admissions in low-income areas.
Romley was emphatic that the $193 million price tag is very conservative and that the costs are likely much higher when doctor visits, medication, long-term care and lost wages are included.
"The status quo is far from free," Romley said. "We can save billions in the whole economy and hundreds of millions in California if we meet federal clean air standards."
RAND looked at other health related uses for the $193 million spent on pollution related hospitalizations. The funds could be used to provide primary care check-ups for every uninsured California child under 14. It could also pay for mammograms for every California woman age 40-64 who is uninsured or on Medi-Cal.
Although RAND does not make policy recommendations, Romley did mention one way that costs from illnesses caused by non-compliance with Federal clean air standards may be recouped.
"The government could send a bill to polluters like was done with tobacco," he said.