Many seniors forced to skip prescription meds

December 04, 2001

Many senior citizens, especially minorities, don't take all their prescription drugs because of inadequate insurance coverage, according to a new study.

Making it difficult for seniors to get needed medications may have hidden costs, says lead study author Michael A. Steinman, M.D., of the San Francisco VA Medical Center and the University of California, San Francisco.

"Policies designed to limit medication use may have serious consequences for patients' health. This can result in increased emergency department visits, nursing home admissions, use of emergency mental health services, and more," says Steinman.

Steinman and colleagues studied a group of approximately 4,900 seniors who regularly used prescription medications. This group was a subset of a larger survey of Americans age 70 or older, called the Survey of Assets and Health Dynamics Among the Oldest Old.

The practice of limiting prescription medication use was common among certain vulnerable groups lacking insurance: minorities, the poor, the sick and those with high out-of-pocket drug costs, they report in the December issue of the Journal of General Internal Medicine.

If study participants in these groups had no insurance, they were far more likely to use their prescription drugs less than those with full or even partial coverage. For example, low-income study participants lacking insurance were about 15 times more likely to limit prescriptions than low-income participants with full coverage, Steinman says.

While some of their study findings were consistent with economic principles, the researchers did not expect to find such a strong independent association between minority ethnicity and noncompliance due to medication cost.

"The reasons for this are unclear. However, minority elders may prioritize prescription drug spending differently than whites in the face of competing economic concerns, including necessities such as food and shelter," Steinman says.

The researchers also note that the combination of high drug costs and inadequate coverage may discourage physicians from prescribing effective medications to patients who can't afford them. Also, since prescription drugs are a large percentage of senior citizens' healthcare costs, "many low income elderly may be forced to choose between their medications and food, clothing or telephone service," Steinman says.

These research findings have important implications for both clinicians and policy makers, according to the study. Physicians should be aware that elderly patients without insurance may be inclined to restrict their prescription use, especially if they belong to minority or low-income groups or have high out-of-pocket drug costs.

"Asking about the impact of medication costs can help physicians identify patients who could benefit from government assistance, industry programs for the medically indigent, or the selection of less-expensive treatments," he says.

Steinman and colleagues also recommend a broader solution. "A more comprehensive coverage plan, and policies that limit medication costs, may help reduce medication restriction. In doing so, we may improve the clinical, economic and social problems that disproportionately affect our most vulnerable seniors," Steinman concludes.
This study was supported in part by the VA National Quality Scholars Fellowship Program and the Agency for Healthcare Research and Quality.

The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.

Posted by the Center for the Advancement of Health ( For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, For information about the Center, call Ira Allen, (202) 387-2829.

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