User login
When Medicare managed care plans raise outpatient copayments, outpatient visits decline, but hospitalizations increase and inpatient stays get longer, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.
Increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care, the researchers concluded (N. Engl. J. Med. 2010;362:320-8).
“In response to increases in ambulatory copayments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I.
“Therefore, increasing such copayments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.
Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased copayments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.
The mean copayment increases were from about $7 to $14 for outpatient primary care and about $12 to $22 for outpatient specialty care, while the control plans kept copayments at about $8 for primary care and $11 for specialty care.
In the year after a plan increased copayments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional hospital admissions per 100 enrollees, adding about 13 additional inpatient days, compared with plans not increasing copayments.
The effect of increased copayments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.
The effect of copayment increases also was magnified among Medicare managed care enrollees with hypertension or diabetes and those with histories of acute myocardial infarction.
The authors reported having no conflicts of interest.
When Medicare managed care plans raise outpatient copayments, outpatient visits decline, but hospitalizations increase and inpatient stays get longer, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.
Increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care, the researchers concluded (N. Engl. J. Med. 2010;362:320-8).
“In response to increases in ambulatory copayments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I.
“Therefore, increasing such copayments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.
Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased copayments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.
The mean copayment increases were from about $7 to $14 for outpatient primary care and about $12 to $22 for outpatient specialty care, while the control plans kept copayments at about $8 for primary care and $11 for specialty care.
In the year after a plan increased copayments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional hospital admissions per 100 enrollees, adding about 13 additional inpatient days, compared with plans not increasing copayments.
The effect of increased copayments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.
The effect of copayment increases also was magnified among Medicare managed care enrollees with hypertension or diabetes and those with histories of acute myocardial infarction.
The authors reported having no conflicts of interest.
When Medicare managed care plans raise outpatient copayments, outpatient visits decline, but hospitalizations increase and inpatient stays get longer, especially among chronically ill beneficiaries and those living in areas of poverty, a study showed.
Increasing cost sharing for ambulatory care among elderly patients may have adverse health consequences and could increase total spending on health care, the researchers concluded (N. Engl. J. Med. 2010;362:320-8).
“In response to increases in ambulatory copayments, the elderly cut back on outpatient visits but are more likely to need expensive hospital care,” said lead author Dr. Amal Trivedi of Brown University, Providence, R.I.
“Therefore, increasing such copayments among the elderly may be an ill-advised cost-containment strategy,” he said in an interview.
Dr. Trivedi and his colleagues compared the use of outpatient and inpatient care between Medicare enrollees in plans that had increased copayments for ambulatory care in a given year and enrollees in matched plans that had not. Nearly 900,000 Medicare beneficiaries were included in the study of 2001-2006 data.
The mean copayment increases were from about $7 to $14 for outpatient primary care and about $12 to $22 for outpatient specialty care, while the control plans kept copayments at about $8 for primary care and $11 for specialty care.
In the year after a plan increased copayments, it would have almost 20 fewer outpatient visits per 100 enrollees but more than two additional hospital admissions per 100 enrollees, adding about 13 additional inpatient days, compared with plans not increasing copayments.
The effect of increased copayments was significantly greater among enrollees in areas with lower average income and education. “We didn't explicitly measure health status, but the increased need for acute hospital care among these enrollees is concerning,” Dr. Trivedi said.
The effect of copayment increases also was magnified among Medicare managed care enrollees with hypertension or diabetes and those with histories of acute myocardial infarction.
The authors reported having no conflicts of interest.