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Raising Co-Pays for Doctor Visits Raises Seniors' Hospital Use
Date:1/27/2010

Study suggests higher cost-sharing for outpatient visits may increase overall spending

WEDNESDAY, Jan. 27 (HealthDay News) -- Boosting co-pays for doctor visits and other outpatient care reduces seniors' use of those services, but it also may have the unintended consequence of sharply increasing hospitalizations, a new study suggests.

That money-saving strategy could end up inflating overall health-care spending and put vulnerable elderly at risk of skimping on needed care, the study authors suggest in a paper published in the Jan. 28 issue of the New England Journal of Medicine.

"From our perspective, it looks like increasing ambulatory-care co-payments for elderly patients is a counterproductive cost-containment strategy," said study author Dr. Amal N. Trivedi, an assistant professor of community health at the Alpert Medical School of Brown University in Providence, R.I. "It's a lose-lose proposition for most health plans because our study suggests it results in more health-care spending, and it's likely to harm the health of enrollees."

The study, involving nearly 900,000 seniors in 36 Medicare managed-care plans, is one of the first large, national examinations of the consequences of raising seniors' co-payments for outpatient services, the authors said.

The new findings are consistent with research on cost-sharing for prescription drugs, which shows that failing to consider the value of the medication or a person's medical and economic status can harm health, the research team noted.

Marsha Gold, a senior fellow at Mathematica Policy Research Inc. in Washington, D.C., said the effect on inpatient care shown in the study "seems a little high." But she agreed that appropriate use of health-care services is always a concern as cost-sharing goes up.

"When you're putting cost-sharing requirements on patients, you need to be aware of the different kinds of effects that it can hav
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