Are Medicare cuts putting men's health in jeopardy?

Maryalene LaPonsie | December 9, 2010

Health insurance company profits are the elephant in the room during many discussions of patient care. While we know private insurers are out to make money, we like to think they put people before profits. Fortunately for seniors, government health care programs such as Medicare are different because they don't need to earn profits. Or do they?

Medicare reimbursements and patient care

While Medicare health insurance and Medicaid don't need to earn profits for shareholders, political pressures and partisan agendas mean that Medicare benefits and Medicaid can be subject to the whims of whatever administration or party has power in Washington.

As the government grapples with how best to reduce the federal deficit, Medicare can find itself a target for those seeking to trim spending. Already, health care reform is making changes to Medicare Advantage health plans, and a recently released report from a federal deficit commission recommends increasing co-payment and co-insurance amounts for Medicare beneficiaries.

Now, it seems that reductions in Medicare reimbursement rates may be having a direct impact on patient care. According to a study, published in the "eJournal of the National Cancer Institute," many physicians are bypassing hormone therapy for low-risk prostate cancer patients as a result of decreased Medicare payments.

Use of hormone therapy for prostate cancer

From 1991-1999, the use of hormone therapy to treat certain types of prostate cancer increased more than threefold. Men who were diagnosed with low risk cancer or those whose cancer was at an advanced stage and had metastasized, or spread to other parts of the body, were given androgen suppression therapy.

Then, from 2004-2005, the use of the hormone therapy dropped by 64 percent for men with low-risk prostate cancer. The sharp decrease corresponded with a 40 percent reduction in Medicare reimbursements for the treatments. Despite an investigation into other possible causes for the decline, researchers determined that the change in Medicare reimbursements was responsible for the reduced use of hormone therapy in these cases.

The study authors note that androgen suppression therapy was never proven to be effective against low-risk prostate cancer. In their findings, it is suggested that the decrease in Medicare reimbursements may have ended the practice of over-treatment of an unproven therapy. They also report that there was no statistically significant change in the use androgen suppression therapy for metastatic cancer patients.

While decreased Medicare reimbursements in this case may not necessarily pose a health risk to men with prostate cancer, the findings do raise serious concerns about how health insurance plans can impact the type of care patients receive. Any time care decisions are dictated by a health plan instead of a physician's expertise is reason to take notice.

Tags : medicare, health insurance

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