[Influence of smoking on medical care expense of middle-aged workers]

An analysis was made to elucidate influence of smoking habits on medical care expense. Subjects were 4,795 male workers aged 40 to 73 who participated in the routine medical check-up in 1988 at a health insurance society in Tokyo. Their daily habits including smoking habit were also surveyed. Data on medical care utilization were derived from the medical records for 1989 provided by the health insurance society. The data on medical care fees were examined, and hospitalization costs analyzed separately. Compared to other subjects, ex-smokers had a higher frequency of having a history of medical care. Ex-smokers showed higher and current smokers lower values of both visiting (percentage of subjects utilizing medical facilities at least once a year) and monthly rate of receiving examinations when compared to non-smokers. Current smokers had the lowest average number of days utilized for medical services, lowest average medical care fee per visit and annual medical care fee per person. The average number of days utilized and annual medical care fee per person was weakly correlated to smoking index. Ex-smokers had the highest average medical care fee per visit. There was a weak correlation to smoking index. Annual medical care fees per person decreased with age in non-smokers, but not in current smokers whose total fees were generally already low. In ex-smokers, fees increased until age fifties. From these results it would be difficult to identify on increase of medical care fees in middle-aged current smokers, especially in active businessmen. While the effect of smoking on health were still subclinical, average medical care fee per visit relate to and reflect the health effects of smoking.