Rising health-care costs have led many Americans to put off
going to the doctor. But a new study confirms what many have
suspected: Postponing care means greater costs in the long run,
particularly for seniors.
The study, appearing today in the New England Journal of
Medicine, showed that many seniors avoided important outpatient
care after their Medicare copayments increased. The result: more
hospital admissions and longer hospital stays.
The findings are consistent with previous studies on the health
care habits of the general population and the poor.
But especially during the current economic downturn, health
experts and advocates for the elderly say seniors are particularly
vulnerable. They are more likely to have fixed incomes and to rely
on market-vulnerable investment income.
Plus, seniors tend to suffer from chronic conditions that
require constant medical care.
"They only have so much money to live on. If their copayments
are going up, and they have a chronic condition, there's only so
many visits they may be able to afford," said Mary Johnson, a
policy analyst for the Senior Citizens League, a nonprofit advocacy
group.
Another factor: the increased popularity of Medicare Advantage
plans, which are run by private companies and offer perks such as
cash back and free gym memberships, but also often require
copayments for doctor visits.
The study, conducted by researchers at Brown University and
Providence (Rhode Island) VA Medical Center, involved nearly
900,000 Medicaid beneficiaries enrolled in 36 Medicare managed-care
plans from 2001 through 2006. In half of the plans, mean copayments
for ambulatory care increased for both primary care ($7.38 to
$14.38) and specialty care ($12.66 to $22.05). Copayments in the
other 18 Medicare plans were unchanged over the study period ($8.33
for primary care; $11.38 for specialty care).
Researchers found that in the year after the increase in
copayments, beneficiaries in those plans had 19.8 fewer outpatient
visits per 100 enrollees, but 2.2 more hospital admissions and 13.4
more inpatient days per 100 enrollees than those in plans where
copayments stayed the same.
Rising costs have forced many public and private insurers to
shift more of those costs to patients. Copayments and deductibles
for many employer-based and Medicaid plans have also increased over
time.
And while just 0.3 percent of Medicare enrollees had plans
requiring a copayment of more than $15 for a primary care visit in
1999, that jumped to 24 percent by 2003.
Jay Wolfson, a public health and medicine professor at the
University of South Florida, explained that there was a good reason
to impose copayments and other out-of-pocket costs, starting back
in the 1960s.
"There was a reasonable expectation that if you erected a
modest financial barrier, it would deter unnecessary utilization
such as people who would go to the doctor whenever they had an
itch," Wolfson said.
By the 1990s and beyond, copayments, deductibles and other
cost-sharing became standard on most health plans.
But the reasoning behind them may be faulty, study authors note.
"Increasing the patient's share of the cost may not reduce (or
may even increase) total health care spending and may result in
worse health outcomes," the study said.
Advocates say that while seniors should recognize that putting
off care now can lead to more problems in the long run, they
understand that many can do nothing about it.
"They have to respond to pocketbook issues," said Cheryl
Matheis, a senior vice president for health strategy with the AARP.
The sagging economy has only made things worse, affecting many
seniors' nest eggs, she said.
Matheis and Johnson said seniors need to know the Medicare
options available to them. Though many are lured by Medicare
Advantage plans that offer zero premiums and other benefits, many
plans require copayments that can increase over time.
Johnson said seniors should take advantage of programs that
offer free counseling about health insurance options. In Florida,
there's the State Health Insurance Assistance Program, or SHINE.
"They're not working for a company, not earning commission,"
Johnson said. "You'll get unbiased advice."
Richard Martin can be reached
at rmartinsptimes.com
or (727) 893-8330
. FAST FACTS
Medicare help
. Medicare.gov allows users to compare Medicare plans available
in their area.
. Floridashine.org is the Web site for the State Health
Insurance Assistance Program. You can also call (800) 963-5337.
. For more Medicare coverage, visit tampabay.com/news/health.
c.2009 St. Petersburg Times