For elderly patients with depression, cost-sharing insurance policies reduce drug use without increasing use of care
Many are concerned that patient cost-sharing policies incorporated in the Medicare Modernization Act may have unintended health consequences, if they reduce essential drug use among the elderly. After two cost-sharing insurance policies were introduced in British Columbia in 2002 and 2003, there was a decline in antidepressant initiation among the elderly, but this decline did not lead to adverse consequences indicated by greater use of other health care services, according to a new study. Neither the copayment policy nor the coinsurance/income-based deductible policy had any significant effect on long-term care admissions, hospitalization rates, psychiatrist visits, or physician visits for elderly patients with depression.
The study population included all seniors living in British Columbia, Canada, during the period 1997 to 2005. In this period, the rate of physician visits per 1,000 seniors increased from 14.26 to 14.98. Visits for depression accounted for 1.4 percent of physician visits, which did not change compared with trends in overall physician visits during the study period. In the same period, visits to psychiatrists increased from 4.73 to 5.48 per 1,000 seniors.
Hospitalization rates for seniors in British Columbia dropped from 25.77 per 1,000 to 18.55 in the 1997 to 2005 period. Approximately 5 percent of total hospitalizations were for depression, which fell from 1.22 to 1.00 per 1,000 seniors. Finally, rates of long-term care admissions fell from 1.89 to 1.5 per 1,000 in this period. The authors state that although these cost-containment policies may have successfully contained nonessential antidepressant use, undertreatment, not nonessential drug use, is by far the greater public health and public policy concern. Therefore, well-designed prescription drug policies should be coupled with interventions to address undertreatment. The study was partly supported by the Agency for Healthcare Research and Quality (HS10881).
See "Impact of drug cost sharing on services use and adverse clinical outcomes in elderly receiving antidepressants," by Philip S. Wang, M.D., Dr.P.H., Amanda R. Patrick, M.S., Colin Dormuth, Sc.D., and others in the Journal of Mental Health Policy and Economics 13, pp. 37-44, 2010.
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