by Matt Kuhrt | Jul 10, 2018 3:18pm
When patients with
chronic conditions lose insurance coverage, the consequences can be severe and
costly. A new study offers a glimpse of the costs of coverage disruptions to
patients and the healthcare system, as well as a sobering look at the potential
scope of the problem.
The results of a new longitudinal study of health outcomes in
adults with Type 1 diabetes published in Health Affairs show a five-fold
increase in utilization of acute-care services following an interruption in
care. The study looked at data from nearly 170,000 adults between the ages of
19 and 64 covered by private insurance.
According to the Bureau
of Labor Statistics, the average worker holds a dozen jobs between the ages of
18 and 50. Given the heavy correlation between health insurance coverage and
employment, that suggests strong potential for transitions on and off of
coverage.
Add a patient population
heavily dependent on daily maintenance in the form of insulin and the results
aren't surprising.
Historically, it hasn't
been easy to obtain or parse data quantifying patient populations that fall
through the cracks of a fragmented healthcare system, said Mary Rogers,
Ph.D., a research associate professor of internal medicine at the University of
Michigan in Ann Arbor and lead author on the study.
Information on Medicare
patients has produced studies of older patients, but data covering working-age
individuals on private plans have only become more available recently through
the release of large data sets from health insurers.
Those data sets aren’t
perfect, but they’re a start, noted Rogers.
“They cost a lot of money
to buy, and they’re large databases, so you have to know how to deal with large
relational databases," she said. "They do contain information
regarding people who are younger than 65, but they don’t include their entire
adulthood because people go in and out of different things."
Other variables can also
limit their utility. For example, the Health Affairs study lacked mortality
data, which means the results exclude patients who died as a result of gaps in
their care.
Like its results, the
study’s policy ramifications appear more obvious than they actually are. The
simplest solution, such as providing Medicare coverage for maintenance care prior
to age 65, seems sensible since, as Rogers pointed out, patients with poorly
controlled Type 1 diabetes frequently wind up with kidney failure, making them
eligible down the road for Medicare coverage for individuals with end-stage
renal disease.
On the other hand, she
said, unless groups of young people with chronic conditions band together to
lobby for action, it’s hard to get much traction, particularly in a political
environment that seems uncertain even for coverage of pre-existing conditions.
The fragmented nature of
the American health system that makes it so difficult to quantify patient
populations who fall through the coverage cracks also makes it difficult to
figure out who should pay and under what circumstances when presented with such
data. From that perspective, the true scope of the problem is likely much
bigger and more consequential given the number of transitions American adults
make in and out of insurance plans and the number of people with chronic
conditions who would potentially benefit from greater continuity of care.
“I suspect that what we
observed is only the tip of the iceberg,” Rogers said.
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