Determinants of U.S. Health Insurance Charges: Evidence from Multivariate Regression

Main Article Content

Pengyuan Qian
School of Mathematics and Statistics, Ningbo University, Ningbo, 315211, China

DOI: https://doi.org/10.70267/lshe.20260111

Keywords

health insurance charges, multivariate regression, smoking, body mass index, risk-based pricing, risk adjustment

Abstract

U.S. national health expenditures accounted for 17.3% of GDP, raising persistent concerns among insurers, policymakers, and households. Using the Medical Cost Personal Dataset (n=1,338), which includes demographic and lifestyle variables, this study examines the determinants of individual health insurance charges. A multivariate regression framework was used to estimate the effects of age, body mass index (BMI), smoking status, number of children, sex, and region. The results indicate that smoking increased the predicted charges by more than $23,000, while age and BMI also had statistically significant positive effects. In contrast, sex and regional differences were not significant after controlling for other factors. The model explained approximately 74% of the variance in charges. These findings align with prior evidence on lifestyle-related risks and provide support for risk-adjusted premium design, highlighting the policy relevance of smoking cessation and obesity prevention.

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References

  • [1] Centers for Medicare & Medicaid Services (CMS). National health expenditure projections 2022–2031. Baltimore, MD: U.S. Department of Health and Human Services, 2023.
  • [2] Swedler, D. I., Miller, T. R., Ali, B., Waeher, G. and Bernstein, S. L. National medical expenditures by smoking status in American adults: an application of Manning’s two-stage model to nationally representative data. BMJ open. 2019, 9(7), p. e026592. https://doi.org/10.1136/bmjopen-2018-026592.
  • [3] Lightwood, J. and Glantz, S. A. Smoking behavior and healthcare expenditure in the United States, 1992–2009: panel data estimates. PLoS medicine. 2016, 13(5), p. e1002020. https://doi.org/10.1371/journal.pmed.1002020.
  • [4] Hansen Edwards, C., Håkon Bjørngaard, J., Minet Kinge, J., Åberge Vie, G., Halsteinli, V., Ødegård, R., Kulseng, B. and Waaler Bjørnelv, G. The healthcare costs of increased body mass index-evidence from The Trøndelag Health Study. Health Economics Review. 2024, 14(1), p. 36. https://doi.org/10.1186/s13561-024-00512-8.
  • [5] Finkelstein, E. A., Trogdon, J. G., Cohen, J. W. and Dietz, W. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates: Amid calls for health reform, real cost savings are more likely to be achieved through reducing obesity and related risk factors. Health affairs. 2009, 28(Suppl1), pp. w822-w831. https://doi.org/10.1377/hlthaff.28.5.w822.
  • [6] Centers for Medicare & Medicaid Services (CMS). National health expenditure data: Personal health care spending by age and gender, 2010–2020. Baltimore, MD: U.S. Department of Health and Human Services, 2020.
  • [7] Göpffarth, D., Kopetsch, T. and Schmitz, H. Determinants of regional variation in health expenditures in Germany. Health economics. 2016, 25(7), pp. 801-815. https://doi.org/10.1002/hec.3200.
  • [8] Skinner, J. and Fisher, E. S. Reflections on geographic variations in U.S. health care. Dartmouth Atlas White Paper. Hanover, NH: Dartmouth Institute for Health Policy & Clinical Practice, 2010.
  • [9] Bolnick, H. J., Hodgson, T. A. and Caplan, C. Health and economic impact of chronic diseases and modifiable risk factors in the United States. Journal of Public Health Management and Practice. 2020, 26(2), pp. 92-99. https://doi.org/10.1097/PHH.0000000000001100.
  • [10] Xu, X., Bishop, E. E., Kennedy, S. M., Simpson, S. A. and Pechacek, T. F. Annual healthcare spending attributable to cigarette smoking: an update. American journal of preventive medicine. 2015, 48(3), pp. 326-333. https://doi.org/10.1016/j.amepre.2014.10.012.
  • [11] Goodchild, M., Nargis, N. and d'Espaignet, E. T. Global economic cost of smoking-attributable diseases. Tobacco control. 2018, 27(1), pp. 58-64. https://doi.org/10.1136/tobaccocontrol-2016-053305.
  • [12] Cawley, J. and Meyerhoefer, C. The medical care costs of obesity: an instrumental variables approach. Journal of health economics. 2012, 31(1), pp. 219-230. https://doi.org/10.1016/j.jhealeco.2011.10.003.
  • [13] Ward, Z. J., Bleich, S. N., Long, M. W. and Gortmaker, S. L. Association of body mass index with health care expenditures in the United States by age and sex. PloS one. 2021, 16(3), p. e0247307. https://doi.org/10.1371/journal.pone.0247307.
  • [14] World Health Organization (WHO) and Organisation for Economic Co-operation and Development (OECD). The heavy burden of obesity: The economics of prevention. Paris: OECD Publishing. , 2019.
  • [15] Zweifel, P., Felder, S. and Meiers, M. Ageing of population and health care expenditure: a red herring? Health economics. 1999, 8(6), pp. 485-496. https://doi.org/10.1002/(SICI)1099-1050(199909)8:6<485::AID-HEC461>3.0.CO;2-4.
  • [16] Institute of Medicine. Variation in Health Care Spending: Target Decision Making, Not Geography. Washington, DC: National Academies Press, 2013.
  • [17] Kim, Y. The effects of smoking, alcohol consumption, obesity, and physical inactivity on healthcare costs: a longitudinal cohort study. BMC Public Health. 2025, 25(1), p. 873. https://doi.org/10.1186/s12889-025-xxxx.
  • [18] Gu, D., Sung, H.-Y., Calfee, C. S., Wang, Y., Yao, T. and Max, W. Smoking-attributable health care expenditures for US adults with chronic lower respiratory disease. JAMA Network Open. 2024, 7(5), pp. e2413869-e2413869. https://doi.org/10.1001/jamanetworkopen.2819203.
  • [19] Nargis, N., Hussain, A. G., Asare, S., Xue, Z., Majmundar, A., Bandi, P., Islami, F., Yabroff, K. R. and Jemal, A. Economic loss attributable to cigarette smoking in the USA: an economic modelling study. The Lancet Public Health. 2022, 7(10), pp. e834-e843. https://doi.org/10.1016/S2468-2667(22)00020-X.
  • [20] Ezendu, K., Pohl, G., Lee, C. J., Wang, H., Li, X. and Dunn, J. P. Prevalence of obesity-related multimorbidity and its health care costs among adults in the United States. Journal of Managed Care & Specialty Pharmacy. 2025, 31(2), pp. 179-188. https://doi.org/10.18553/jmcp.2025.31.2.179.
  • [21] Adjei, N. N., Haas, A., Sun, C. C., Zhao, H., Yeh, P. G., Giordano, S. H., Toumazis, I. and Meyer, L. A. Healthcare Costs in the United States by Demographic Characteristics and Comorbidity Status. Value in Health. 2025, 28(2), pp. 206-214. https://doi.org/https://doi.org/10.1016/j.jval.2024.10.3847.

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Published
Feb 4, 2026
Conference Proceedings Volume
Vol. 12 (2026): Proceedings of the 2026 International Conference on Life Sciences and Health Engineering (IC-LSHE 2026)
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Articles
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This work is licensed under a Creative Commons Attribution 4.0 International License.

How to Cite

Qian, Pengyuan. “Determinants of U.S. Health Insurance Charges: Evidence from Multivariate Regression”. Exploring Science Academic Conference Series, vol. 12, Feb. 2026, pp. 89-97, https://doi.org/10.70267/lshe.20260111.

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