How Medicare Affects Health Status
Seniors Have Inferior Access to Quality Healthcare and Medicines
Prescription drugs are the fastest growing component of health care expenditures. Many seniors have no Medicare prescription coverage and must pay out of pocket.
The access to and utilization of the health care system is one of the major dimensions of inequalities in health outcomes. The materialistic aspect of this dimension includes the ability to purchase health care, the ability to purchase medicines, and establishing a relationship with one physician.
For Medicare patients, relevant questions include:
Do higher quality doctors serve only patients of higher socioeconomic status, who may have supplementary coverage to their Medicare? Does the healthcare system treat patients with Medicare differently than patients with more thorough coverage? How does Medicare affect patients’ ability to comply fully with doctors’ instructions?
Patients move through four stages as they access healthcare services. Preventive care includes screening and maintaining an ongoing relationship with the doctor. Diagnosis and entry into the healthcare system include concerns of access and admission to a hospital. Treatment efficacy takes into account making an informed decision and quality of care. Follow-up and readmission includes following the doctor’s advice and the ability to obtain medicine. In all four stages, Medicare can influence a patient’s access to healthcare services.
For example, Medicare may not pay for one cholesterol panel per year for its patients, even if the doctor has started a lipid-lowering medication. Doctors are frustrated that Medicare has the lowest level of physician reimbursement for services rendered compared to any other insurer.
Financial status affects treatment efficacy and follow-up care when a patient is unable to afford the medications prescribed by the doctor. In fact, patients of lower socioeconomic status have higher mortality following treatment or diagnosis for several types of cancer. Patients who can’t afford supplementary coverage to their Medicare may find themselves eliminating nutritious foods from their diet just to pay for medications.
It isn’t uncommon to hear of patients in their 70’s that take menial jobs just so they can pay for their medications, when they should be resting or recovering from illness. An insidious aspect of this is the energy these patients must expend just to survive, energy that patients could spend exploring other treatment options, getting a second opinion, and becoming informed about the illness.
Two factors contribute to the Medicare problem: lack of government funding, and the growing size of the elderly population due to improved medicine and technology. Americans feel strongly about prolonging life but no one wants to accept responsibility for the financial repercussions of this. There is inadequate prescription medication coverage for the population that has the majority of the medical problems and therefore need the most medications. This can lead to patients who refuse to take important medications or who skip days of medications to stretch out their prescription.
The specter of medical malpractice encourages doctors to do as much as possible, as treating patients aggressively lessens the possibility of a lawsuit. However, the gap between coverage of services and usage of services remains large for underinsured patients.
Our culture of medicine cleaves doctors and patients into two categories at odds with each other: the practitioner offering aggressive life-extending medicines and interventions, and the patient wanting these invasive treatments but unable to pay for them. Perhaps this paradox arises not from insufficient Medicare coverage or a litigious society but from our demand for aggressive treatment: we expect a “cure.” Our medicine isn’t just a product of medical progress and government spending but of our choices.
Related article: 2008 Medicare Rx Plan Changes
Sources:
Feinstein, J.S. (1993). The Relationship Between Socioeconomic Status and Health: A Review of the Literature. The Millbank Quarterly, 71, 279-320.
Fleming, H. (2000). Managed Care Organizations Gear Up for Medicare Rx Debate. Drug Topics, 144, 98.
