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Rheumatoid Arthritis Patients with HMO Coverage May Not Have Access to New Medications

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www.ProHealth.com • November 6, 2002


Health maintenance organizations strive to lower the cost of rheumatoid arthritis care by reducing the use of new medications, not by lowering the number of hospital admissions or surgeries, according to research recently presented at the American College of Rheumatology Annual Scientific Meeting in New Orleans, Louisiana.

Most of the studies on the impact of health maintenance organizations (HMOs) and access to quality care have been conducted on healthy populations. These studies indicate that HMOs save costs by lowering the use of hospital stays. However, studies of the impact of HMOs on people with rheumatoid arthritis do not find that HMOs lower health care use, including hospital admissions, total joint replacement surgeries or outpatient surgeries.

In a study of 493 individuals, researchers analyzed whether people with rheumatoid arthritis receiving care from HMOs are less likely to use anti-TNF agents (etanercept or infliximab) or COX-2 inhibitors to treat their disease. The research shows that people with rheumatoid arthritis who participate in HMOs were significantly less likely to receive any form of anti-TNF therapy or COX-2 inhibitors.

"In recent years, several expensive new medications have been approved by the U.S. Food and Drug Administration for the care of individuals with rheumatoid arthritis. This study indicates that rheumatoid arthritis patients in HMOs are much less likely to receive these new medications." said Edward Yelin, PhD, Professor of Medicine and Health Policy, University of California-San Francisco, and a lead investigator in the study.

"Since we had previously found that HMOs do not reduce the use of the hospital or surgery for such patients, controlling medications may be the way that they seek to reduce the costs of treating people with this disease."

The American College of Rheumatology is the professional organization for rheumatologists and health professionals who share a dedication to healing, preventing disability and curing arthritis and related rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see www.rheumatology.org.



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