The American Society on Aging is pleased to acknowledge the aarp Andrus Foundation, based in Washington, D.C., for funding "Research Today." This section was written by Aging Today associate editor April Thompson.
RESEARCH TODAYTHE INSURANCE IMPACT--HOW POLICIES CAN AFFECT CARE
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The American Society on Aging is pleased to acknowledge the aarp Andrus Foundation, based in Washington, D.C., for funding "Research Today." This section was written by Aging Today associate editor April Thompson. |
Much of the public-policy debate on healthcare for elders in the United States has centered on how best to pay for insurance. Some researchers, though, are examining the effect of insurance itself on the health of elders. Does having a Medigap policy make a difference? Do high out-of-pocket expenses for insurance premiums or uncovered expenses like prescription drugs alter the health status of elders? This "Research Today" section explores some recent findings by those who are asking such questions.
Medigap, Death And Disability
Medicare beneficiaries who hold private supplemental insurance tend to delay disability longer than those lacking such Medigap policies--and once a disabling condition sets in, their odds of not dying within the year are far better, according to a new study from the University of Massachusetts, Boston (UMass). Elders at a high level of functioning who lacked Medigap insurance were found to be up to 34% more likely than Medigap enrollees to become disabled in an activity of daily living, and as much as 53% more apt to die within a year.
The study also found that the chance of developing disability is up to 60% higher for elders reporting financial barriers to care, according to researcher Frank Porell of UMass Gerontology Institute. He and coauthor Helen Miltiades, who is now at Boston College, tracked year-to-year health changes using 19911996 data from the Medicare Current Beneficiary Survey, an annual study of Medicare beneficiaries conducted by the Health Care Financing Association (hcfa).
Supplemental insurance aims to mend some of Medicare's holes, particularly its high copayments and lack of drug coverage. A Medigap plan must fit within a set of 10 federally standardized policy designs ranging from basic coverage (providing the Part A coinsurance for hospital stays over 60 days and the 20% copayment required by Part B to receive doctor or outpatient care) to higher-end policies offering prescription drugs and other benefits. Insurers that adhere to basic federal guidelines can sell any of these policies; they are free to compete with other companies on pricing and services. The study indicates that eight in 10 Medicare recipients have private supplementary insurance, and one-third of these policies cover prescription drugs.
Previous
studies have shown that Medicare recipients with supplemental insurance are
more likely to make a yearly physician visit, to receive preventive services
and to have a steady source of care. In contrast, beneficiaries who lack Medigap-type
coverage are more likely to end up in a hospital rather than receive outpatient
services, to endure long waits in the doctor's office and to put off care because
of cost.
The study, "Access to Care and Functional Status Change Among Aged Medicare Beneficiaries," builds on the work of Lawrence Landerman and colleagues at Duke University, Durham, N.C. Using seven years of longitudinal data, those researchers found that the risk of developing a disability were up to 49% higher for elders without private insurance coverage. The UMass results suggest that having insurance coverage and access to healthcare is most crucial at the beginning stages of disability. "Supplemental insurance coverage does seem to have a protective effect against disability but its protection is largely limited to those who are functionally independent," Porell noted. "Once a person is disabled, any further protective effect is overwhelmed by the progression of disease itself."
Mortality statistics, however, revealed a higher risk of death for those without Medigap coverage who are either healthy or disabled, except for those with severe disability in activities of daily living such as eating or bathing. The data showed that "the odds of dying within a year were estimated to be between 37% and 53% lower among Medicare beneficiaries with private supplementary insurance." Surprisingly, whether or not one's insurance covered prescription drugs did not seem to affect the risk of death or disability, said Porell. "We're not exactly sure why," he said, but he suggested further studies should examine the effects of rising pharmaceutical prices and of the generosity of the coverage.
The study, which was funded by the AARP Andrus Foundation, also found that death and disability rates were much higher for those who reported trouble accessing care, particularly for financial reasons such as high costs of care or services not being covered. The chances of becoming disabled within a year among functionally independent beneficiaries are 33% greater for those who report trouble in accessing care, 38% for people who delay care, and 60% for elders who forgo care because of financial reasons, the researchers stated. Those who complained of long travel times to their regular providers, who were unable to access care or who were dissatisfied with service availability also proved to be more likely to become disabled with some instrumental activity of daily living such as doing housework or shopping for groceries.
Medicare HMOs
In a separate analysis, Porell and Miltiades scrutinized the same data to see how elders enrolled in Medicare HMOs fared. When it comes to delaying disability and reducing risk of death, managed care seems to be as beneficial as having a Medigap policy supplementing a traditional Medicare plan, they said. "This is important for policy purposes in that no adverse disability or mortality outcomes were associated with Medicare HMO enrollment," said Porell.
They also argued against recommendations by some economists to tax medicare supplemental insurance premiums to make up for the added burden that some believe such coverage imposes on the Medicare program, because elders who have Medigap insurance use more services covered by Medicare in the short term. Porell emphasized, "If individuals with private supplementary insurance are less likely to become disabled and die, [this coverage actually offers] potential savings to the Medicare program."
Contact Frank Porell at (617) 287-7239; e-mail: frank.porell@ems.umb.edu.
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