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Increased Medicare Copayments Affect Care Usage

Rising costs reduce outpatient visits, but the decline is offset by an increase in hospitalizations

WEDNESDAY, Jan. 27 (HealthDay News) -- In elderly patients, increasing copayments for ambulatory care may result in adverse health consequences and increased health care spending, according to a study in the Jan. 28 issue of the New England Journal of Medicine.

Amal N. Trivedi, M.D., of the Alpert Medical School of Brown University in Providence, R.I., and colleagues studied usage of outpatient and inpatient care in 899,060 beneficiaries who were enrolled in 36 Medicare plans between 2001 and 2006.

The researchers found that mean copayments for primary care and specialty care nearly doubled for beneficiaries enrolled in plans that increased copayments for ambulatory care (from $7.38 to $14.38 and from $12.66 to $22.05, respectively). Compared to control plans that did not increase copayments, they estimated that plans that increased cost sharing were associated with 19.8 fewer annual outpatient visits per 100 enrollees, 2.2 additional annual hospital admissions per 100 enrollees, 13.4 additional annual inpatient days per 100 enrollees, and a 0.7 percent increase in the proportion of hospitalized enrollees.

"The effects of copayment increases on the subsequent use of inpatient care were magnified for enrollees living in areas with low income and low educational levels, for black enrollees, and for enrollees who had hypertension, diabetes, or a history of acute myocardial infarction as compared with the effects observed for the entire study cohort," the authors write.

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