Responses to Medicare Drug Costs among Near-Poor versus Subsidized Beneficiaries
Responses to Medicare Drug Costs among Near-Poor versus Subsidized Beneficiaries
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DOI：
10.1111/1475-6773.12062
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发表时间：
2013-10-01
影响因子：
3.4
通讯作者：
Hsu, John
中科院分区：
文献类型：
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作者：
Fung, Vicki;Reed, Mary;Hsu, John
目的关于医疗保险D部分低收入补贴(LIS)的保护价值的信息有限。我们比较了近乎贫困的LIS接受者(相当于联邦贫困水平的200%)和没有LIS的较高收入受益者对药品成本的反应。数据来源/研究设置2008年的Medicare Advantage受益者。研究设计我们使用多变量Logistic回归分析了三种药物成本反应：成本降低行为(例如，改用仿制药)、不坚持(例如，不再补充处方)和经济压力(例如，不再补充必需品)。数据收集分层随机样本中的电话访谈(N=1,201，应答率70%)。主要发现无补贴的近乎贫困的人(26%)和较高收入的受益者报告了降低成本的行为(23%，p=.63)；较少的LIS受益者报告了降低成本的行为(15%，p=0.019 vs.近乎贫穷)。与收入较高(3.5%，p=.049)和LIS受益人(3.1%，p=.027)相比，没有补贴的近贫困受益人更有可能降低遵从性(8.2%)。与收入较高的受益人(11%，p=.050)和LIS受益人(11%，p=.015)相比，接近贫困的受益人(20%)也更频繁地感受到由于药品成本造成的经济压力。结论低收入补贴提供了保护，使其免受药品成本相关的违约和经济压力的影响。略高于LIS收入门槛的受益人面临这些潜在不利行为的风险最大。
ObjectiveThere is limited information on the protective value of Medicare Part D low-income subsidies (LIS). We compared responses to drug costs for LIS recipients with near-poor (200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS.Data Sources/Study SettingMedicare Advantage beneficiaries in 2008.Study DesignWe examined three drug cost responses using multivariate logistic regression: cost-reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities).Data CollectionTelephone interviews in a stratified random sample (N=1,201, 70 percent response rate).Principal FindingsAfter adjustment, a comparable percentage of unsubsidized near-poor (26 percent) and higher income beneficiaries reported cost-reducing behaviors (23 percent, p=.63); fewer LIS beneficiaries reported cost-reducing behaviors (15 percent, p=.019 vs near-poor). Unsubsidized near-poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent, p=.049) and LIS beneficiaries (3.1 percent, p=.027). Near-poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent, p=.050) and LIS beneficiaries (11 percent, p=.015).ConclusionsLow-income subsidies provide protection from drug cost-related nonadherence and financial stress. Beneficiaries just above the LIS income threshold are most at risk for these potentially adverse behaviors.