Higher copays mean a higher incidence of unnecessary acute care visits, thereby placing elderly patients at higher risk for significant medical problems if not caught earlier. This, according to a study just published in the NEJM. This trial sheds light on a phenomenon not adequately studied until now because of numerically inadequate elderly subjects for study and the absence of reliable Medicare claims data.

Patients affected were principally enrolled in Medicare Advantage (MA) plans whose premium copays increased.  They were compared to patient cohorts whose plans did not increase copay amounts for a 5 year period (2001-2006). The shifting of the cost of care burden to the patient resulted in the findings of almost 20 fewer annual outpatient visits per 100 enrollees in the year after the rise in copayments and 13 more annual inpatient days per 100 enrollees of MA.

Although study limitations were quite notable for the lack of randomization among specific medical diagnoses (non-randomized controlled mechanism); the use of primary care versus specialty care measurements; and the lack of the inclusion of the measurements of cost-shifting on future hospital visits — the basic take-home message is the same: increased out-of-pocket healthcare costs for ambulatory (office) visits for elderly patients mean decreased secondary prevention of adverse medical consequences and higher healthcare costs overall, owing to increased use of hospital services. | LINK

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