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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3016 — Out-of-Pocket Payment and Chronic Conditions among Older Veterans with Medicare Coverage

Chen GJ (Charleston TREP), Moran WP (Charleston TREP), Jia H (VAMC at Gainesville, FL), Mauldin P (Charleston TREP), Mueller M (Charleston TREP), Durkalski V (Charleston TREP), Egede LE (Charleston TREP)

To examine effect of chronic conditions on out-of-pocket payment for medical treatment in community-dwelling older veterans with Medicare coverage.

We used data from the 2002 Medicare Current Beneficiary Survey (MCBS) to examine association of chronic conditions with out-of-pocket expenditures. Subjects’ veteran status was ascertained based on MCBS self-reported data. We excluded subjects who were younger than 65 years of age or were living in nursing homes. The primary outcome was amount of out-of-pocket payment for medical treatment. The chronic conditions included hypertension, cardiovascular heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD), cancer, diabetes, arthritis, and mental illness. In addition, degree of functional status was assessed with activity of daily living (ADL=0-6) and instrumental activity of daily living (IADL=0-6) scores, difficulty eating solid food, and presence of incontinence. Descriptive and multivariate regression analyses were performed. The log-transformed payment amount was used as a dependent variable in the multivariate regression model.

Of the 2768 older veterans, 91% were white, 6% African American, and 3% all others. Mean age was 75.7 years (SD=6.3). The average out-of-pocket payment was $1,600 per person-year (SD=$2,988) and the median payment was $828 per person-year. Comparing veterans with and without specified chronic disease and adjusting for demographics (age, gender, race), residence area, and HMO participation, it was found that a veteran’s out-of-pocket payment was 40% higher if they had CHD (p < 0.001), 33% higher if they had hypertension (p < 0.001), 37% higher if they had cancer (p < 0.001), 37% higher if they had diabetes, 21% if they had mental illness, 18% higher if they had COPD, and 14% higher if they had arthritis. For every increase of one ADL difficulty, the out-of-pocket payment increased by 10% (p < 0.01). Difficulties in IADLs, eating solid food, or having incontinence did not have significant impact on the out-of-pocket payment (p > 0.05).

Chronic conditions such as CHD, hypertension, cancer, diabetes, mental illness, COPD, arthritis, as well as ADL impairments pose a significant and disproportionate financial burden on elderly veterans.

Out-of-pocket cost burden falls most heavily on those elderly veterans with chronic health conditions. Whether the financial burden affects a patient’s outcome requires further studies.

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