 |
|
Supplemental Insurance and Mortality in Elderly Americans
Findings From a National Cohort
Mark P. Doescher, MD, MSPH;
Peter Franks, MD;
Jessica S. Banthin, PhD;
Carolyn M. Clancy, MD
Arch Fam Med. 2000;9:251-257.
Context As the burden of out-of-pocket health care expenditures for Medicare beneficiaries has grown, the need to assess the relationship between uncovered costs and health outcomes has become more pressing.
Objective To assess the relationship between risk for out-of-pocket expenditures and mortality in elderly persons with private supplemental insurance.
Design Retrospective cohort study using proportional hazards survival analyses to assess mortality as a function of health insurance, adjusting for sociodemographic, access, and case mix–health status measures.
Setting The 1987 National Medical Expenditure Survey, a representative cohort of the US civilian population, linked to the National Death Index.
Participants A total of 3751 persons aged 65 years and older.
Main Outcomes Measures Five-year mortality rate.
Results After 5 years, 18.5% of persons at low risk for out-of-pocket expenditures, 22.5% of those at intermediate risk, and 22.6% of those at high risk had died. After multivariate adjustment, a significant linear trend (P = .02) toward increasing mortality with increasing risk category was observed. Compared with the low-risk group, persons in the intermediate-risk group had an adjusted hazard ratio of 1.2 (95% confidence interval, 0.9-1.6), whereas those in the high-risk group had an adjusted hazard ratio of 1.4 (95% confidence interval, 1.0-1.9).
Conclusions Increasing risk for out-of-pocket costs is associated with higher subsequent mortality among elderly Americans with supplemental private coverage. Although research is needed to identify which specific components of out-of-pocket expenditures are adversely associated with health outcomes, findings support policies to decrease out-of-pocket health care expenditures to reduce the risk for premature mortality in elderly Americans.
From the Department of Family Medicine, University of Washington School of Medicine, Seattle (Dr Doescher); the Department of Family Medicine, Primary Care Institute, University of Rochester, Rochester, NY (Dr Franks); Center for Cost and Financing Studies, (Dr Banthin) and Center for Outcomes and Effectiveness Research (Dr Clancy), Agency for Healthcare Research and Quality, Rockville, Md.
RELATED ARTICLE
THE Archives of Familly Medicine Continuing Medical Education Program
Arch Fam Med. 2000;9(3):267-269.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Book Review: The Impact of Cost-Sharing on Appropriate Utilization and Health Status: A Review of the Literature on Seniors
Rice and Matsuoka
Med Care Res Rev 2004;61:415-452.
ABSTRACT
|
