HEALTHCARE UTILIZATION PATTERNS AMONG MEDICARE BENEFICIARIES WITH FINANCIAL CONSTRAINTS
Author(s)
Justice Sheehama, MPH, Pei-Lin Huang, MS, Eberechukwu Onukwugha, MSc, PhD;
University of Maryland School of Pharmacy, Department of Practice, Sciences and Health Outcomes Research, Baltimore, MD, USA
University of Maryland School of Pharmacy, Department of Practice, Sciences and Health Outcomes Research, Baltimore, MD, USA
OBJECTIVES: Financial constraints can influence medication management and healthcare utilization patterns. Little is known about how distinct cost-related management strategies (CrMS) are associated with healthcare utilization. This study aimed to evaluate the associations between distinct CrMS and healthcare utilization among Medicare beneficiaries.
METHODS: This study utilized the 2022 Medicare Current Beneficiary Survey Public Use File. Respondents were included if they participated in all three survey rounds. Distinct CrMS included cost-related nonadherence (CRNA), cost-reduction strategy, and spending less on other basic needs to afford medication. We defined the following outcomes in the past 12 months: 1) inpatient admission; 2) outpatient visit. Guided by a published behavioral model, we used sequential multivariable logistic regression models to examine the associations between CrMS and outcomes, adjusting for demographic, enabling and need factors. We reported adjusted odds ratios (AOR) and 95% confidence intervals (CI).
RESULTS: Among 7,095 respondents, 55% were female, 49% were older adults aged 75+ years, and 74% were Non-Hispanic White. Overall, 12% reported CRNA, 25% used cost-reduction strategies, and 11% spent less on basic needs. In the fully adjusted model, only CRNA (AOR=1.39; 95% CI: 1.01-1.89) and cost-reduction strategies (AOR=1.38; 95% CI: 1.08-1.76) were associated with higher odds of an inpatient admission. In the fully adjusted model of an outpatient visit, cost-reduction strategies were associated with higher odds of outpatient visits (AOR=1.27; 95% CI: 1.13-1.43), while spending less on basic needs was associated with lower odds of outpatient visits (AOR=0.82; 95% CI: 0.69-0.98). Cost-related nonadherence was no longer associated with outpatient visits after adjusting for need factors.
CONCLUSIONS: Despite Medicare coverage, survey respondents employed CrMS. Additionally, CrMS differed in its association with inpatient admissions and outpatient visits. Future studies will be needed to isolate the relevant mechanisms (e.g., foregone care) and identify appropriate interventions.
METHODS: This study utilized the 2022 Medicare Current Beneficiary Survey Public Use File. Respondents were included if they participated in all three survey rounds. Distinct CrMS included cost-related nonadherence (CRNA), cost-reduction strategy, and spending less on other basic needs to afford medication. We defined the following outcomes in the past 12 months: 1) inpatient admission; 2) outpatient visit. Guided by a published behavioral model, we used sequential multivariable logistic regression models to examine the associations between CrMS and outcomes, adjusting for demographic, enabling and need factors. We reported adjusted odds ratios (AOR) and 95% confidence intervals (CI).
RESULTS: Among 7,095 respondents, 55% were female, 49% were older adults aged 75+ years, and 74% were Non-Hispanic White. Overall, 12% reported CRNA, 25% used cost-reduction strategies, and 11% spent less on basic needs. In the fully adjusted model, only CRNA (AOR=1.39; 95% CI: 1.01-1.89) and cost-reduction strategies (AOR=1.38; 95% CI: 1.08-1.76) were associated with higher odds of an inpatient admission. In the fully adjusted model of an outpatient visit, cost-reduction strategies were associated with higher odds of outpatient visits (AOR=1.27; 95% CI: 1.13-1.43), while spending less on basic needs was associated with lower odds of outpatient visits (AOR=0.82; 95% CI: 0.69-0.98). Cost-related nonadherence was no longer associated with outpatient visits after adjusting for need factors.
CONCLUSIONS: Despite Medicare coverage, survey respondents employed CrMS. Additionally, CrMS differed in its association with inpatient admissions and outpatient visits. Future studies will be needed to isolate the relevant mechanisms (e.g., foregone care) and identify appropriate interventions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR115
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance, Patient Behavior and Incentives
Disease
No Additional Disease & Conditions/Specialized Treatment Areas