Study: Copays backfire with seniors

Raising patients copayments for doctor visits to reduce insurers costs is counterproductive, at least with seniors, a new Brown University study shows, because it leads them to cut back on routine care, get sicker and require costly hospitalizations.
Insurers have known for decades that raising copays discourages consumers from going to the doctor too often. But the conventional wisdom was it did not affect their health. This study, featured in the Jan. 28 issue of the New England Journal of Medicine, contradicts that notion.
Dr. Amal Trivedi, an assistant professor of medical science in the Department of Community Health at Browns Warren Alpert Medical School, looked at Medicare data for nearly 900,000 beneficiaries across the country, all over age 65.
Trivedi and his team compared 18 Medicare plans with increased copayments for outpatient care and 18 that offered similar coverage but had kept copayments steady. Average copays in the pricier plans had risen from $7.38 to $14.38 for primary care, and from $12.66 to $22.05 for specialty care. For the plans where copays remained constant, seniors paid an average of $8.33 for primary care and $11.38 for specialty care.
During the following year, health plans with increased copays saw doctor visits drop significantly, by nearly 20 visits per year per 100 members. But their hospital admissions also rose, by 2.2 per 100 members, or 13.4 inpatient days per year per 100 enrollees.
The plans with steady copays, meanwhile, saw little change.
Because inpatient hospital care is far more expensive than doctor visits, the study concluded that raising copays for doctor visits does not make financial sense, at least for plans covering seniors. The negative effects are particularly dramatic, Trivedi found, with lower-income seniors and with patients with hypertension, diabetes or a history of heart problems.
It is a lose-lose proposition for most health plans, Trivedi said in a news release. The study goes against findings of studies from the early 1970s that didnt find a negative effect on consumers’ health, he noted, but those studies had not included elderly patients.
Trivedi said he hopes insurers use the data to reduce or at least not increase the amount of money Medicare beneficiaries must pay to see their doctors.
The research was funded by a Pfizer Health Policy Scholars Award and a career development award from the Veterans Affairs Health Services Research and Development Service. Trivedi worked with graduate student Husein Moloo and Vincent Mor, chair of the Department of Community Health at Brown.
The full text of the study is available, free of charge, on the NEJM Web site.