Supplemental insurance and mortality in elderly Americans

Findings from a national cohort

M. P. Doescher, Peter Franks, J. S. Banthin, C. M. Clancy

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)251-257
Number of pages7
JournalArchives of Family Medicine
Volume9
Issue number3
StatePublished - 2000
Externally publishedYes

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Insurance
Health Expenditures
Mortality
Confidence Intervals
Delivery of Health Care
Premature Mortality
Diagnosis-Related Groups
Health Insurance
Survival Analysis
Medicare
Health Care Costs
Health Status
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Supplemental insurance and mortality in elderly Americans : Findings from a national cohort. / Doescher, M. P.; Franks, Peter; Banthin, J. S.; Clancy, C. M.

In: Archives of Family Medicine, Vol. 9, No. 3, 2000, p. 251-257.

Research output: Contribution to journalArticle

Doescher, M. P. ; Franks, Peter ; Banthin, J. S. ; Clancy, C. M. / Supplemental insurance and mortality in elderly Americans : Findings from a national cohort. In: Archives of Family Medicine. 2000 ; Vol. 9, No. 3. pp. 251-257.
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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.",
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