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Testing the added value of self-reported health and well-being in understanding healthcare utilization and costs



We investigated the relationship between measures of self-reported health and well-being and concurrent and prospective healthcare utilization and costs to assess the added value of these self-reported measures in understanding utilization and cost.


Kaiser Permanente members (N = 6752) completed a 9-item survey measuring life evaluation, financial situation, social support, meaning and purpose, physical health, and mental health. Responses were linked to medical record information during the period 12 months before and after the survey.


Correlations between health and well-being measures and healthcare utilization and cost variables were generally weak, with stronger correlations for future life evaluation and selected health measures (ρ = .20–.33, ps < .001). Better overall life evaluation had a significant but weak association with lower total cost and hospital days in the following year after controlling for age, sex, and race/ethnicity (p < .001). Full multivariate models, adjusting for age, sex, race/ethnicity, prior utilization, and relative risk models, showed weak associations between health and well-being measures and following year total healthcare cost and utilization, though the associations were relatively stronger for the health variables than the well-being variables.


Overall, the health and well-being variables added little to no predictive utility for future utilization and cost beyond prior utilization and cost and the inclusion of predictive models based on clinical information.

Perceptions of well-being may be associated with factors beyond healthcare utilization. When information about prior use is unavailable, self-reported health items have some predictive utility.

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Data availability

Data are proprietary of Kaiser Permanente and not available for public use.

Code availability

SAS code available upon request.


  1. After we merged the HWBS responses with the EMR data (n = 7935), we excluded 1183 members who did not have at least 12 months of KP enrollment before and after the survey, resulting in our sample size of 6752. We decided not to use listwise deletion for missing data to keep the data as complete as possible. As such, the sample sizes reported for each of the analyses may have some slight variations. The average percentage of missing data across the variables was .42%, with a range of 0.00 to 4.10%.”.


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We want to thank Marianne McPherson, Julia Nagy, and Allie Lonstein from the Institute for Healthcare Improvement’s 100 Million Healthier Lives initiative metrics team for their continued support throughout the project. And also, we would like to thank Kaiser Permanente’s Utility for Care Data Analysis for helping with data extraction and Nancy P. Gordon for additional guidance related to the Member and Community Health and Well-Being Survey. Partial financial support was received from the Institute for Healthcare Improvement.


Partial financial support was received from the Institute for Healthcare Improvement.

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Authors and Affiliations



TS contributed to conceptualization, data curation, methodology, project administration, writing–original draft, writing–review and editing, and submission. CR contributed to statistical analysis, conceptualization, writing–review, and editing, . BR contributed to conceptualization, writing–review, and editing. MS contributed to conceptualization, data curation, methodology, writing–original draft, writing–review, and editing.

Corresponding author

Correspondence to Matthew C. Stiefel.

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Conflict of interest

CR and BR received funding from the Institute for Healthcare Improvement and Heluna Health to support their efforts in developing and implementing the measurement framework for the 100 Million Healthier Lives initiative and Wellbeing in the Nation. BR and CR additionally received grant funding from the Robert Wood Johnson Foundation to support related work.

Ethical approval

This study was deemed exempt from a full institutional review board review by the Kaiser Foundation Research Institute’s National Compliance Officer.

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Informed consent was obtained from all individual participants included in the study.

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Not applicable.

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Straszewski, T., Ross, C.A., Riley, C. et al. Testing the added value of self-reported health and well-being in understanding healthcare utilization and costs. Qual Life Res (2022).

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  • Health and well-being
  • Well-being
  • Healthcare cost
  • Healthcare utilization