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Arch Fam Med. 2000 Mar;9(3):251-7.

Supplemental insurance and mortality in elderly Americans. Findings from a national cohort.

Author information

1
Department of Family Medicine, University of Washington School of Medicine, Seattle, USA. mdoesche@u.washington.edu

Abstract

CONTEXT:

As the burden of out-of-pocket health care expenditures for Medicare beneficiaries has grown, the need to assess the relationship between uncovered costs and health outcomes has become more pressing.

OBJECTIVE:

To assess the relationship between risk for out-of-pocket expenditures and mortality in elderly persons with private supplemental insurance.

DESIGN:

Retrospective cohort study using proportional hazards survival analyses to assess mortality as a function of health insurance, adjusting for sociodemographic, access, and case mix-health status measures.

SETTING:

The 1987 National Medical Expenditure Survey, a representative cohort of the US civilian population, linked to the National Death Index.

PARTICIPANTS:

A total of 3751 persons aged 65 years and older.

MAIN OUTCOMES MEASURES:

Five-year mortality rate.

RESULTS:

After 5 years, 18.5% of persons at low risk for out-of-pocket expenditures, 22.5% of those at intermediate risk, and 22.6% of those at high risk had died. After multivariate adjustment, a significant linear trend (P = .02) toward increasing mortality with increasing risk category was observed. Compared with the low-risk group, persons in the intermediate-risk group had an adjusted hazard ratio of 1.2 (95% confidence interval, 0.9-1.6), whereas those in the high-risk group had an adjusted hazard ratio of 1.4 (95% confidence interval, 1.0-1.9).

CONCLUSIONS:

Increasing risk for out-of-pocket costs is associated with higher subsequent mortality among elderly Americans with supplemental private coverage. Although research is needed to identify which specific components of out-of-pocket expenditures are adversely associated with health outcomes, findings support policies to decrease out-of-pocket health care expenditures to reduce the risk for premature mortality in elderly Americans.

PMID:
10728112
[Indexed for MEDLINE]

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