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Student Research: Copays Don’t Reduce Use of Medicare Home Health Care, Study Shows

May 8, 2017

In hopes of reducing Medicare spending, policymakers have proposed to charge seniors a copay for home-based care, figuring that senior citizens will use it less if it isn’t free. However, a new study in JAMA Internal Medicine by lead author Qijuan “Emily” Li, a public health doctoral student and others, casts doubt on that premise.

“We found no evidence that imposing a copayment reduced the use of home health care,” said senior author Dr. Amal Trivedi, associate professor in the Brown University School of Public Health.

Yet what a copay policy would do is increase out-of-pocket costs for homebound seniors.

“If we are increasing the copay with little impact on utilization for certain services, essentially we are just adding to the financial burden of the patients,” said Li.

No significant difference

Last year Republicans in the U.S. House of Representatives and former President Barack Obama, a Democrat, both proposed copays for the currently free Medicare benefit. The presumed reduction in seniors’ usage, plus the copay revenues, would recoup $1.3 billion to Medicare over 10 years, they estimated.

“Spending on home health care has increased rapidly over the last decade, and policymakers are concerned about that,”Trivedi said. “Very little unites Washington these days, but apparently members of both political parties agree that imposing copayments for home health care is an important thing to do. But no recent studies have looked at what happens when older patients have to pay out-of-pocket for these services.”

Trivedi, Li and their co-authors figured out a way to conduct just such a study. They gathered reams of data to analyze what has happened when private Medicare Advantage plans assessed copays for the benefit.

Read more of David Orenstein's story on copays and medicare