How Medicare's Payment Cuts For Cancer Chemotherapy Drugs Changed Patterns Of Treatment
How Medicare's Payment Cuts For Cancer Chemotherapy Drugs Changed Patterns Of Treatment
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DOI：
10.1377/hlthaff.2009.0563
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发表时间：
2010-07-01
期刊：
影响因子：
9.7
通讯作者：
Newhouse, Joseph P.
中科院分区：
文献类型：
--
作者：
Jacobson, Mireille;Earle, Craig C.;Newhouse, Joseph P.
2003 年颁布的《医疗保险处方药、改进和现代化法案》从 2005 年 1 月起大幅降低了门诊化疗药物的支付率。我们评估了这些降低如何影响新诊断肺癌的医疗保险受益人接受化疗的可能性和设置，以及他们接受的药物类型。与对获取途径的担忧相反，我们发现这些变化实际上增加了肺癌患者接受化疗的可能性。所施用的化疗药物的类型也发生了变化。医生们从分配盈利能力下降幅度最大的药物卡铂和紫杉醇转向其他高利润药物，如多西紫杉醇。我们不知道这对癌症患者有什么影响，但这些变化可能抵消了立法通过所预计节省的部分费用。最终的信息是，支付改革会产生实际后果，应谨慎实施。
The Medicare Prescription Drug, Improvement, and Modernization Act, enacted in 2003, substantially reduced payment rates for chemotherapy drugs administered on an outpatient basis starting in January 2005. We assessed how these reductions affected the likelihood and setting of chemotherapy treatment for Medicare beneficiaries with newly diagnosed lung cancer, as well as the types of agents they received. Contrary to concerns about access, we found that the changes actually increased the likelihood that lung cancer patients received chemotherapy. The type of chemotherapy agents administered also changed. Physicians switched from dispensing the drugs that experienced the largest cuts in profitability, carboplatin and paclitaxel, to other high-margin drugs, like docetaxel. We do not know what the effect was on cancer patients, but these changes may have offset some of the savings projected from passage of the legislation. The ultimate message is that payment reforms have real consequences and should be undertaken with caution.