Uninsured Adults With Chronic Illnesses Use More Health Care Services When They Qualify For Medicare

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Uninsured adults with common chronic illnesses had greater healthexpenditures and more frequent physician office visits andhospitalizations after they became eligible for Medicare compared withthose who had insurance before age 65, according to a study publishedThursday 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 Studyto compare Medicare expenses for 1,385 people who were uninsured beforebecoming eligible for the program at age 65 and 3,773 who had privatecoverage before becoming eligible for Medicare (Emery, Reuters, 7/11).

Accordingto the study, 2,951 beneficiaries were diagnosed with eithercardiovascular disease or diabetes -- conditions for which treatmentcan prevent severe consequences that can require extra doctor visitsand hospitalization. Health care expenses were 51% greater forpreviously uninsured beneficiaries who were diagnosed with chronicconditions before they turned age 65, the study found. In addition, thepreviously 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 andexpenditures after age 65 did not differ significantly betweenpreviously insured and uninsured adults," according to the study (Reuters, 7/11).

Leadresearcher John Ayanian, an associate professor of medicine and healthcare policy at Harvard, said the study suggests the cost of providinguniversal health coverage might be less then expected, because it wouldprevent people from waiting until late in life to receive treatment forchronic illnesses. Ayanian said, "A lot of the prior research focusedon the health benefits of extending insurance coverage. Our studysuggested that it may be cost effective" (New York Times, 7/12).

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Commonwealth FundPresident Karen Davis in a statement said, "This study highlights theimportance of health insurance coverage for all Americans to improvethe efficiency of our health care system, as well as the quality of ourhealth 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 ofpotential Medicare savings if coverage had been provided earlier forthe uninsured. However, he said, "I could hazard a guess that societywould save money, and there is no question these people would behealthier and have a higher quality of life if they had insuranceearlier." Weiner said, "Health care is especially expensive for thisage group," adding, "Fixing this part of the problem clearly will notbe cheap, and exactly where health insurance policy would impactlongevity 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 apartial savings," adding, "You get some money back, but it's stillgoing 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 couldinclude assigning case managers who would make sure patients take theirdrugs or report high levels of blood sugar for diabetics, rather thanjust paying for doctors and leaving beneficiaries to seek their owncare. "Health insurance is supposed to not just prevent thecomplications of chronic diseases but also to keep you healthier,"McClellan said, adding that Medicare "historically has not done a verygood job of that" (New York Times, 7/12).
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