Extreme heat drives $1B in excess healthcare utilization per year, study estimates

Emergency visits and inpatient admissions for conditions related or adjacent to extreme heat events are costing the U.S. healthcare system more than $1 billion per year, a tally that could likely increase should climate change not be addressed, according to a new analysis.

The study—released online Monday and currently being submitted for publication in a scientific journal—found between 2016 and 2020 an average of roughly 234,000 excess emergency department visits across the country tied to heat event days. Excess hospital admissions averaged just over 56,000, according to the study conducted by Virginia Commonwealth University (VCU) and the Center for American Progress, a nonpartisan public policy advocacy group.

Assuming the national average emergency department visit and hospitalization costs of $757 and $14,900, respectively, those numbers translate to about $177.3 million and $835 million in average excess healthcare utilization costs per summer, multidisciplinary researchers at the university wrote.

“Unless we take action to mitigate the effects of climate change, heat events are projected to keep increasing in frequency, resulting in an even greater blow to public health,” Steven Woolf, M.D., a professor at the VCU School of Medicine and a senior fellow at the Center for American Progress, said in a release from the university.

Of note, the national findings are an extrapolation of environmental and care utilization data for the state of Virginia. Though the range of climatic conditions in Virginia “is typical of much of the country,” researchers wrote that some areas have more extreme conditions. Additionally, different communities across the country would have varying levels of comorbidities and local infrastructure to protect from extreme heat.

Within Virginia alone, the researchers found that heat event days led to an additional 400 ambulatory care visits, 7,000 emergency department visits and 2,000 heat-related hospital admissions on average each summer.                                    

Though their numbers aren’t an exact national picture, researchers wrote that the trend of increased healthcare utilization during heat events is clear.

A 2022 JAMA study cited in the VCU report estimated that a heat wave in the Pacific Northwest during June 2021 was estimated in a different study to increase emergency department visits for heat-related illnesses ninefold in Seattle and 17-fold in Portland—numbers in line with region-level utilization data the VCU researchers pulled from the Centers for Disease Control and Prevention (CDC).

The past several weeks of excessive heat patterns in the Southern U.S. have also placed additional strain on healthcare facilities. CDC data and news reports alike have highlighted increased emergency department visits associated with heat-related illnesses across healthcare facilities in Texas, Oklahoma, New Mexico, Arkansas and Louisiana.

The researchers added that the health impacts of extreme are “larger than official statistics suggest” as many more individuals do not seek medical attention for their heat-related illnesses. Extreme heat can impact individuals’ mental health, they wrote, and heat-related power outages could hamper home medical devices such as oxygen pumps and dialysis machines.

With longitudinal weather data from the Environmental Protection Agency outlining a steady increase in heat wave days per year since the 1960s, the researchers called for policy changes to address climate change broadly and to prepare communities for extreme heat events.

“All levels of government must take on responsibilities to protect public health and physical infrastructure from extreme heat, improve data collection and prediction capabilities, raise public awareness, increase community resilience and strengthen health care services and the early detection of heat-related illness,” the researchers wrote. “These efforts are necessary everywhere, but especially in low-income neighborhoods, communities of color, and other settings where vulnerability to severe weather and climate change is greatest.”

Outside of the additional strain, extreme weather events ranging from heat waves to hurricanes and wildfires have impacted operations across the majority of healthcare providers within the past five years alone, according to a congressional report released late last year. Specifically, 63 provider organizations told Congress that they saw an average of 4.2 such events over the last half-decade, the cost of which ran them $28,000 to $22 million in facility damages or service interruptions.

Interest in addressing their own role in climate change has led more than 100 health systems, payers, drug manufacturers, associations and other industry organizations to sign onto a Biden administration greenhouse gas and climate resilience pledge. That voluntary commitment included a 50% greenhouse gas emission reduction by 2030 and the release of a climate resilience plan for continuous operations by the end of 2023, among other goals.