Cost-related skipping of medications and other treatments among Medicare beneficiaries between 1998 and 2000. Results of a national study.
OBJECTIVE
To report rates of cost-related skipping of medications and other treatments, assess correlates of skipping, examine changes in skipping between 1998 and 2000, and identify factors associated with changes in skipping.


METHODS
Cross-sectional and longitudinal analyses of surveys of a probability sample of Medicare beneficiaries in 13 states in 1998 and 2000.


METHODS
Self-reported rates of skipping medications and other treatments.


RESULTS
Cost-related skipping rates increased from 9.5% in 1998 to 13.1% in 2000. In separate multivariable models using 1998 and 2000 data, higher out-of-pocket costs, lower physician-patient relationship quality, low income, and lacking prescription drug coverage were associated with more skipping (P<.05 for all). Better physical and mental health, and greater age were associated with less skipping (P<.05). HMO membership was not associated with higher rates of skipping in 1998 (P=.84), but was in 2000 (P<.0004). In longitudinal analyses, increased medication costs and HMO membership were associated with the observed increase cost-related skipping between 1998 and 2000.


CONCLUSIONS
Cost-related skipping was associated with several factors, including drug coverage, poverty, poor health, and physician-patient relationship quality. The important role of physician-patient relationships in cost-related skipping has not been shown previously. Physicians should be aware of these risk factors for cost-related skipping, and initiate dialogue about problems paying for prescription medications and other treatments.
Wilson
Ira B
IB
The Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA 02111, USA. iwilson@tufts-nemc.org
Rogers
William H
WH
Chang
Hong
H
Safran
Dana Gelb
DG
D000368:Aged; D003430:Cross-Sectional Studies; D004358:Drug Therapy / Q000191:economics*; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D008297:Male; D006278:Medicare; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012646:Self Administration; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014481:United States