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Li Q, Keohane LM, Thomas K, Lee Y, Trivedi AN. Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees. JAMA Intern Med. 2017;177(7):1012–1018. doi:10.1001/jamainternmed.2017.1058
Do copayments reduce the use of home health care among older adults?
In this case-control study of 36 Medicare Advantage plans, increased copayments for home health care were not associated with changes in the proportion of enrollees receiving home health care, the number of home health episodes per user, or home health days per user.
We found no evidence that imposing copayments meaningfully reduces the use of home health care, but such cost sharing may add substantially to the burden of out-of-pocket spending among frail older adults.
Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy.
To determine the association of home health copayments with use of home health services.
Design, Setting, and Participants
A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans.
Introduction of copayments for home health care between 2007 and 2011.
Main Outcomes and Measures
Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care.
Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, −0.15 percentage points; 95% CI, −0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, −0.01 to 0.03), and home health days per user (adjusted difference-in-differences, −0.19; 95% CI, −3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care.
Conclusions and Relevance
We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.
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