{"id":239134,"date":"2010-01-27T17:01:56","date_gmt":"2010-01-27T22:01:56","guid":{"rendered":"http:\/\/blogs.wsj.com\/health\/2010\/01\/27\/study-higher-co-pays-mean-more-trips-to-the-hospital\/"},"modified":"2010-01-27T17:01:56","modified_gmt":"2010-01-27T22:01:56","slug":"study-higher-co-pays-mean-more-trips-to-the-hospital","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/239134","title":{"rendered":"Study: Higher Co-Pays Mean More Trips to the Hospital"},"content":{"rendered":"

\"Stethoscope\"A new study in the New England Journal of Medicine<\/a> has a provocative finding: Bigger co-payments for primary-care and specialty doctor visits were tied to more in-patient hospital time for elderly patients. <\/p>\n

The implication is that people avoided the doctor\u0092s office to save money, then ended up in the hospital when their problems weren\u0092t detected or treated in their early stages. The apparent effect seemed stronger among people living in low-income areas, and for those with high blood pressure, diabetes or a history of heart attack, among other groups.<\/p>\n

The bottom line was that raising co-pays \u0093may be a self-defeating cost-containment strategy and may have adverse health consequences,\u0094 says Amal Trivedi, the study\u0092s lead author and a professor at Brown\u0092s Alpert Medical School. <\/p>\n

The result is generally consistent with a number of other studies, many focused on patients\u0092 out-of-pocket costs for drugs. They’ve linked higher co-pays to reduced use of medications, and vice versa. Here\u0092s one of those<\/a> and here’s another<\/a>. Advocates of so-called value-based benefits design point to them as evidence for why insurers and employers should try to align patients\u0092 financial incentives with the care they most need, particularly preventive treatment for chronic conditions.<\/p>\n

But it cuts against the general trend toward larger out-of-pocket charges for consumers, particularly in employer-provided plans. It also seems to point in a different direction than the granddaddy of all studies looking at the issue, the Rand Health Insurance Experiment<\/a>, which suggested in the early 1980s that consumer cost-sharing tended to bring down doctor visits and hospital stays. Trivedi, who is a recipient of a Pfizer Health Policy Scholars Award, said one reason may be that the new study focused on Medicare participants, while the Rand version excluded the elderly. It\u0092s not clear if his new findings can be generalized to the non-elderly population, he said. <\/p>\n

The new study looked at enrollees in privately administered Medicare plans that increased copayments for ambulatory care (to a mean of $14.38 from $7.38 for primary care, and to $22.05 from $12.66 for specialty). It compared them to people with plans that didn\u0092t boost copayments. The total study population included nearly 900,000 beneficiaries enrolled in 36 plans between 2001 and 2006. In the year after the increase, the authors estimated that the plans that increased the charges had 19.8 fewer annual outpatient visits, and 2.2 additional annual hospital admissions and 13.4 more annual inpatient days, per 100 beneficiaries. Limits to the study included that the enrollees weren’t randomized, and that it observed only a relatively short period of time. <\/p>\n

Image: iStockphoto<\/em><\/p>\n

<\/img><\/a>
\n<\/img><\/a><\/p>\n

\n<\/img><\/a> <\/img><\/a> <\/img><\/a> <\/img><\/a> <\/img><\/a>\n<\/div>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

A new study in the New England Journal of Medicine has a provocative finding: Bigger co-payments for primary-care and specialty doctor visits were tied to more in-patient hospital time for elderly patients. The implication is that people avoided the doctor\u0092s office to save money, then ended up in the hospital when their problems weren\u0092t detected […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-239134","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/239134","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/comments?post=239134"}],"version-history":[{"count":0,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/239134\/revisions"}],"wp:attachment":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/media?parent=239134"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/categories?post=239134"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/tags?post=239134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}