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Spring 2014
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THE BEAT
 
They'll Pay for That
Increased co-payments mean higher costs later for seniors.
For years, health care experts believed that higher co-payments helped control health care costs. Patients  faced with the higher price tag, they theorized, would cut back on unnecessary visits, saving themselves and insurers money. In fact, studies from the early 1970s concluded that patients cut back on doctor visits when the cost of their insurance co-payments went up, and their health wasn’t affected. The flaw in their logic, says Amal Trivedi, assistant professor of community health, was that those studies did not include the elderly.

Trivedi and his team of researchers have looked at Medicare data involving nearly 900,000 beneficiaries  across the country aged over 65. They compared 18 Medicare plans with increased co-payments for  outpatient care and 18 that offered similar coverage but kept co-payments steady. Their findings, detailed in the January 28, 2010, edition of the New England Journal of Medicine, have implications for insurers and  politicians seeking ways to control costs but also improve quality of care.

“It is a lose-lose proposition for most health plans,” says Trivedi. “Our study suggests that when you raise  co-payments for ambulatory care among elderly beneficiaries, particularly those with low incomes, lower education, and chronic disease, they do cut back on their outpatient care but are more likely to need expensive hospital care.”

Trivedi and his team also found that the negative effects were particularly magnified among lower income  senior citizens and among patients who had hypertension, diabetes or a history of heart problems.

The study “answers important questions,” Trivedi says. “We have almost no data for elderly patients on the effect of increasing outpatient payments. Our study suggests that increasing these co-payments for the elderly is an ill-advised cost-containment strategy.”
 
 
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