Increase in health care costs led to decrease in initiation of treatment among older patients

Higher co-payment costs have led to a decrease in the initiation of necessary medical care among older patients with diabetes, hypertension and hypercholesterolemia.

A retrospective cohort study included data from 17,183 retired patients with 31 different types of employer-provided drug coverage during 1997 and 2002. Patients were aged between 65 years and 74 years; more women than men were included in the study.

Researchers examined the time it took patients with newly diagnosed diabetes, hypertension or hypercholesterolemia to start treatment and found that higher co-payments were associated with an overall delayed initiation of medical care.

When co-payments were doubled, large reductions were observed among the predicted proportion of patients initiating pharmacotherapy at one and five years following diagnosis.

The initiation of treatment decreased for patients newly diagnosed with diabetes from 45.8% to 40% after one year and from 69.3% to 62.9% after five years. The percentage of patients initiating treatment for newly diagnosed hypertension decreased from 54.8% to 39.9% after one year and from 81.6% to 66.2% after five years. For patients with hypercholesterolemia, the proportion of patients initiating treatment decreased from 40.2% to 31.1% after one year and from 64.3% to 53.8% after five years.

Patients with diabetes and no previous use of drug therapy had a median initiation of drug use after diagnosis of more than 1,402 days; median initiation was sooner for patients with hypertension (833 days) and hypercholesterolemia (1,170 days).

Five years after diagnosis, 36% of patients with hypercholesterolemia, 32.5% of patients with diabetes and 21.5% of patients with hypertension remained untreated.

“These results raise concerns about high cost-sharing levels for the elderly, insured patients without experience using prescription drugs,” the researchers wrote. “Based on our findings, high cost-sharing levels could be a barrier to treatment for this population and possibly result in poor health outcomes. Policy makers and physicians should consider the effects of benefits design on patient behavior to encourage the adoption of necessary care.”

Solomon M. Arch Intern Med. 2009; 169: 740-748.

If someone told a 'man on the street' that a medical study was conducted that showed that persons subjected to higher costs of health care were less likely to comply with the recommendations for that care, he might find it silly, or perhaps more accurate, trivial and inconsequential. The tragedy of our current payment system is sadly that it was necessary and useful to conduct this study. The findings are so relevant to the issues many patients have with following our recommendations for optimal care.

– Zachary T. Bloomgarden, MD

Endocrine Today Editorial Board member