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Life Health > Health Insurance > Medicare Planning

Missing Medical Appointments Kills Clients: Researchers

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What You Need to Know

  • The researchers started with data from the peak COVID-19 lockdown period.
  • The found an 11-percentage-point increase in 12-month mortality for patients ages 46 through 55.
  • For patients 56 through 64, the increase was about 14 percentage points.

Simply missing one outpatient medical appointment could increase a typical client’s relative risk of dying in the next 12 months by more than 10 percentage points.

A team of researchers led by Engy Ziedan, an economist at Tulane University, has published data supporting that estimate in a new working paper based on patient record data gathered before and after the March 13, 2020, start of the COVID-19 pandemic emergency period.

Patients and care providers canceled many appointments because of the effects of the pandemic on the health care system and concerns about contagion.

Overall, the cancellations led to 22.8 extra deaths per 10,000 among people under age 65, and 48.5 extra deaths per 10,000 people ages 65 and older, the researchers found.

That means the patients under age 65 suffered one extra death, over the expected baseline level, per 438 canceled appointments, and patients ages 65 and older suffered one extra death per 206 canceled appointments.

What It Means

For insurance advisors helping clients with mortality-based products such as life insurance, one implication is that clients who report missing their most recent scheduled medical appointments might need more life insurance than other information about the clients would suggest.

Similarly, for insurance and retirement advisors helping clients with income planning arrangements, such as annuities, tontines, cash-value life insurance and asset withdrawal strategies, reports that clients were able to get their most recent schedule imply that those clients might outlive the standard life expectancy forecasts. Those clients might need more longevity protection than other clients.

The Research

A working paper is a research paper that has not yet been through a full peer review process. The authors might change and expand the paper to include new data and new ideas.

Ziedan wrote the paper together with Kosali Simon and Coady Wing, two researchers at Indiana University. They published their paper on the website of the National Bureau of Economic Research.

The researchers conducted the research by analyzing about 70 million patient records from the Healthjump electronic medical records database. The database includes data on physician practices, stand-alone clinics and hospital outpatient clinics that offer scheduled appointments, but not urgent care clinics or hospital emergency rooms.

To study the effects of appointment cancellations, the researchers compared records for the 30-day period before March 13, 2020, and the 30-day after.

The researchers contend that the cancellation effects they detected were not driven by COVID-19 deaths, because the 12-month COVID-19 death totals were similar for patients who had appointments in the 30-day period before March 13 and the 30-day period that started March 13.

The patient and appointment mix appear to be similar for both groups, but the post-emergency appointments had 1,469 more cancellations per 10,000 appointments.

“Appointment cancellation rates were 77% higher for people with appointments in the shutdown period,” the researchers write.

Laboratory test rates for patients with post-shutdown appointments were 35% lower.

Overall, a 10% increase in health care appointments reduced mortality rates by about 2.9%, and 10,000 cancellations produced about 30 extra deaths, the researchers say.

That implies about one extra death for every 333 cancellations, the researchers estimate.

Age and Health Status

Older people tend to be much more likely to die than sicker people, and people with health problems tend to be much more likely to die than healthier people.

In 2019, for example, before the COVID-19 pandemic made the headlines, the United States reported about 1 death per year for 1,000 residents ages 15 through 34, and roughly 1 death per year for every 115 residents ages 55 through 64, according to National Center for Health Statistics data.

But the effects of medical appointment cancellations led to big increases in the otherwise low expected death rates for young people and healthy people as well as for other people, the researchers found.

Here are the estimated increases in actual mortality rates, when compared with the expected levels, broken down by age group for patients with missed appointments:

  • 0-17: 15 percentage points higher
  • 18-25: 9.3 percentage points higher
  • 26-35: 8.3 percentage points higher
  • 36-45: 9.6 percentage points higher
  • 46-55: 11 percentage points higher
  • 56-64: 14 percentage points higher
  • 65 and older: 20 percentage points higher

Similarly, cancellations increased 12-month death risk by 9.6 deaths per 10,000 cancellations in the group of patients with no known chronic conditions, 26 extra deaths per 10,000 cancellations for patients with heart disease, and 293 extra deaths per 10,000 cancellations for patients with cancer.

That means cancellations caused one extra death per 1,0142 cancellations for patients who appeared to be health, one extra death per 385 cancellations for patients for patients with heart disease, and one extra death per 34 cancellations for patients with cancer.

The researchers conclude that “cancellation shock” might explain one-quarter to one-third of the excess U.S. deaths from causes other than COVID-19 that occurred between March 2020 and March 2021.

A good focus for future research would be studying the effects of different types of outpatient care, to see which types of care have the most impact on people’s health, the researchers say.

Another Analysis

Gravie, a company in the individual coverage health reimbursement arrangement market, found that 54% of 1,000 consumers polled in August said they had delayed or canceled a medical exam or procedure due to cost, and 59% reported that they had experienced negative consequences from delaying medical exams, treatments or procedures.

The results imply that missed care might be affecting relatively young, healthy, working-age populations as well as older, sicker people.


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