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Recent increases in insurance copayment levels have encouraged senior citizens to delay getting outpatient care and treatment until their conditions become acute, according to research by two Brown professors and a former graduate student.

Assistant Professor of Community Health Amal Trivedi, who led the study, said insurance copayments have increased substantially in recent years. He attributes the change to a decrease in insurance companies' coverage, which makes patients pay more out-of-pocket expenses in order to dissuade them from unnecessary treatment.

Several past studies have supported this reasoning regarding the general population, Trivedi said. But senior citizens require special medical attention, as their health is generally in worse condition and can degrade rapidly. They often live on fixed incomes, though, so they do not have much disposable income, he said.

According to the group's research, if subjected to higher copayments, elder patients are likely to avoid treatment until their condition becomes acute — which often requires them to spend extra money on hospitalization and treatment for more serious illnesses that develop.

"Increasing copay is a counter-productive cost-containment strategy," Trivedi said. "When it comes to treating elders, increasing copayment leads to an overall increase in cost and a reduction in health outcome. It is a lose-lose situation."

The researchers compared changes over the course of two years in patient use of health services with 18 insurance plans that increased copayment levels and 18 other plans that held their copayments fixed.

Trivedi worked on the study with Husein Moloo MPH'08 and Vincent Mor, professor of medical science and chair of the Department of Community Health. Mor said the research group is in the process of reaching out to various insurance companies to push for a change in the private market.

"Though further categorization of which patients and which services to restrict copayments on will make health insurances that much more complicated," Mor said, "this will be beneficial for both the companies and the patients."

The article, titled "Increased Ambulatory Care Copayments and Hospitalizations among the Elderly," was published in the Jan. 28 issue of the New England Journal of Medicine.




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