Supplemental Insurance and Mortality in Elderly Americans

Results: After 5 years, 18.5% of persons at low risk for out-of-pocket expenditures, 22.5% of those at interme- diate risk, and 22.6% of those at high risk had died. Af- ter multivariate adjustment, a significant linear trend (P = .02) toward increasing mortality with increasing risk category was observed. Compared with the low-risk group, persons in the intermediate-risk group had an adjusted hazard ratio of 1.2 (95% confidence interval, 0.9-1.6), whereas those in the high-risk group had an adjusted haz- ard ratio of 1.4 (95% confidence interval, 1.0-1.9). Conclusions: Increasing risk for out-of-pocket costs is associated with higher subsequent mortality among el- derly Americans with supplemental private coverage. Al- though research is needed to identify which specific com- ponents of out-of-pocket expenditures are adversely associated with health outcomes, findings support poli- cies to decrease out-of-pocket health care expenditures to reduce the risk for premature mortality in elderly Americans.