OBJECTIVES: The knowledge of health cost drivers help in strategic planning for optimizing existing resources use. The aim of this research was to study the association between individual health plan paid costs and population characteristics.

METHODS: We conducted an analytical cross-sectional study on the association between health plan paid costs and demographic variables and the presence of certain diseases. The study population was compound of 174,818 individuals, 46.14% male and with a mean age 43.50 + - 21.92 years, from a private health plan in Santa Catarina, Southern Brazil, in 2017. The source of the data was the Business Intelligence system maintained by Qualirede. The demographic characteristics investigated were sex and age. The selected diseases were hypertension, diabetes, COPD, obesity and cancer. Age was stratified as follows: child 0 to 12 years old, young 13 to 17; adult 18 to 39, middle age 40 to 59 and elderly from 60 years old. To analyze data, multiple linear regressions were used, with a significance level p <0.05.

RESULTS: The average cost for males was US$ 122.26 lower than for females (p <0.001). Compared to adults, children had an average cost US$ 271.38 lower (p <0.001), young people US$ 263.64 lower (p <0.001), middle age US$ 310.94 higher (p <0.001) and the elderly US$ 974.69 higher (p <0.001). Compared to individuals without comorbidity, the average cost of those with diabetes was US$ 696.97 higher (p <0.001), with hypertension US$ 823.74 higher (p <0.001) and with cancer US$ 9,719.64 higher (p <0.001). There was no significant difference for individuals with COPD and obesity.

CONCLUSIONS: Sex, age and presence of diseases were determinants of care costs in Santa Catarina, Southern Brazil. These results indicate on which groups health promotion and disease prevention actions will have the greatest impact on cost reduction.