Benefits Improvement and Protection Act's impact on transplantation rates among elderly MEDICARE beneficiaries with end-stage renal disease.
Benefits Improvement and Protection Act's impact on transplantation rates among elderly MEDICARE beneficiaries with end-stage renal disease.
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《福利改善和保护法案》对患有终末期肾病的老年医疗保险受益人移植率的影响。
DOI：
10.1097/tp.0b013e3182774366
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发表时间：
2013
期刊：
影响因子：
6.2
通讯作者：
Bartlett,StephenT
中科院分区：
文献类型：
--
作者：
Mullins,CDaniel;Jain,Rahul;Weir,MatthewR;Franey,ChristineS;Shih,Ya-ChenTina;Pradel,FrançoiseG;Bikov,Kaloyan;Bartlett,StephenT
背景《福利改善和保护法》（BIPA）扩大了老年患者和其他符合医疗保险条件的终末期肾病（ESRD）患者的移植后免疫抑制剂的医疗保险覆盖范围，但保留了仅因ESRD状态而符合条件的患者的3年限制。我们的目的是确定BIPA的影响，老年患者（年龄≥ 65岁）受BIPA.MethodsMedicare索赔和美国肾脏数据系统标准分析文件中的肾移植的可能性进行了分析，老年患者中，所有这些人都受到BIPA，与非老年人，其中许多人不受BIPA。一个差异中的差异的方法和广义Logistic回归被用来估计BIPA的impact. Results 632，904 ESRD医疗保险受益人符合纳入/排除标准的数据分析表明，BIPA使老年患者更有可能（相对似然，1.36; 95%置信区间，1.32-1.41）有移植。非老年患者的可能性下降后BIPA（相对似然，0.93; 95%置信区间，0.92-0.94）。ConclusionTransplantation rates increased among those elderly patients，所有这些人都受到BIPA的影响，通过扩大免疫抑制剂覆盖BIPA。这些结果表明，消除移植后护理的经济障碍可能会对移植率产生积极影响，但也提出了法律是否将移植从年轻患者转移到老年患者的问题。
BackgroundThe Benefits Improvement and Protection Act (BIPA) expanded Medicare coverage for posttransplantation immunosuppresants for elderly patients and others eligible for Medicare beyond their end-stage renal disease (ESRD) status yet retained the 3-year limit for patients eligible solely because of ESRD status. Our objective was to determine BIPA’s impact on renal transplantation among elderly patients (age≥ 65 years) affected by BIPA.MethodsMedicare claims and the US Renal Data System Standard Analysis Files were used to analyze the likelihood of transplantation among elderly patients, all of whom were affected by BIPA, versus the nonelderly, many of whom were unaffected by BIPA. A difference-in-differences approach and generalized logistic regressions were used to estimate BIPA’s impact.ResultsAnalysis of data for 632,904 ESRD Medicare beneficiaries who met inclusion/exclusion criteria suggests that BIPA made elderly patients more likely (relative likelihood, 1.36; 95% confidence interval, 1.32–1.41) to have a transplant. The likelihood for nonelderly patients decreased following BIPA (relative likelihood, 0.93; 95% confidence interval, 0.92–0.94).ConclusionTransplantation rates increased among those elderly patients, all of whom were affected by BIPA by extending immunosuppressant coverage under BIPA. These results suggest that removing financial barriers to posttransplantation care may positively impact transplantation rates yet raise questions regarding whether the law shifted transplants from younger to older patients.