Uninsured Adults With Chronic Illnesses Use More Health Care Services When They Qualify For Medicare Than Those Who Were Insured, Study Finds

Main Category: Public Health
Also Included In: Medicare / Medicaid / SCHIP;  Health Insurance / Medical Insurance
Article Date: 16 Jul 2007 - 5:00 PDT

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Uninsured adults with common chronic illnesses had greater health expenditures and more frequent physician office visits and hospitalizations after they became eligible for Medicare compared with those who had insurance before age 65, according to a study published Thursday in the New England Journal of Medicine, Reuters reports. For the study, researchers from Harvard Medical School used data from the federal Health and Retirement Study to compare Medicare expenses for 1,385 people who were uninsured before becoming eligible for the program at age 65 and 3,773 who had private coverage before becoming eligible for Medicare (Emery, Reuters, 7/11).

According to the study, 2,951 beneficiaries were diagnosed with either cardiovascular disease or diabetes -- conditions for which treatment can prevent severe consequences that can require extra doctor visits and hospitalization. Health care expenses were 51% greater for previously uninsured beneficiaries who were diagnosed with chronic conditions before they turned age 65, the study found. In addition, the previously uninsured beneficiaries had 13% more doctor visits and 20% more hospitalizations than the previously insured group (Kolata, New York Times, 7/12).

"However, among adults without these conditions, adjusted health care use and expenditures after age 65 did not differ significantly between previously insured and uninsured adults," according to the study (Reuters, 7/11).

Lead researcher John Ayanian, an associate professor of medicine and health care policy at Harvard, said the study suggests the cost of providing universal health coverage might be less then expected, because it would prevent people from waiting until late in life to receive treatment for chronic illnesses. Ayanian said, "A lot of the prior research focused on the health benefits of extending insurance coverage. Our study suggested that it may be cost effective" (New York Times, 7/12).

Reaction
Commonwealth Fund President Karen Davis in a statement said, "This study highlights the importance of health insurance coverage for all Americans to improve the efficiency of our health care system, as well as the quality of our health care and health outcomes" (Reuters, 7/11).

Jonathan Weiner, professor of health policy at the Johns Hopkins Bloomberg Schools of Public Health, said he was disappointed that the study did not include an estimate of potential Medicare savings if coverage had been provided earlier for the uninsured. However, he said, "I could hazard a guess that society would save money, and there is no question these people would be healthier and have a higher quality of life if they had insurance earlier." Weiner said, "Health care is especially expensive for this age group," adding, "Fixing this part of the problem clearly will not be cheap, and exactly where health insurance policy would impact longevity is unclear" (Edelson, HealthDay/Washington Post, 7/11).

Mark Pauly, a health economist at the University of Pennsylvania Wharton School, said, "The quick interpretation is, 'Well this saves money,' but it's a partial savings," adding, "You get some money back, but it's still going to cost money" to implement a universal coverage system.

Former CMS Administrator Mark McClellan, a visiting fellow at the AEI-Brookings Joint Center for Regulatory Studies, said a more effective system for providing care to the uninsured could include assigning case managers who would make sure patients take their drugs or report high levels of blood sugar for diabetics, rather than just paying for doctors and leaving beneficiaries to seek their own care. "Health insurance is supposed to not just prevent the complications of chronic diseases but also to keep you healthier," McClellan said, adding that Medicare "historically has not done a very good job of that" (New York Times, 7/12).

The study is available online.

Broadcast Coverage
American Public Media's "Marketplace Morning Report" on Thursday reported on the study. The segment includes comments from study author Michael McWilliams (Barshay, "Marketplace Morning Report," American Public Media, 7/12). Audio and a transcript of the segment are available online.

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