Digesting the doughnut hole
Digesting the doughnut hole
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DOI：
10.1016/j.jhealeco.2013.04.007
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发表时间：
2013-12-01
影响因子：
3.5
通讯作者：
Goldman, Dana P.
中科院分区：
文献类型：
--
作者：
Joyce, Geoffrey F.;Zissimopoulos, Julie;Goldman, Dana P.
尽管取得了成功，但医疗保险D部分因覆盖范围的差距而受到广泛批评，即所谓的“甜甜圈洞”。我们比较了受覆盖率差距影响的受益人与未受覆盖率差距影响的受益人之间处方药的使用情况，发现覆盖率差距确实扰乱了老年糖尿病患者处方药的使用。但使用量的下降是适度的，集中在成本较高的品牌药物。对高成本药物的需求，如抗精神病药、抗哮喘药和中枢神经系统药物，在覆盖缺口内下降了8-18%，而对低成本药物的使用，如β受体阻滞剂、ACE抑制剂和抗抑郁药，在达到差距后，具有高通用渗透率的药物下降了3-5%。更重要的是，药物依从性较低与医疗服务使用的增加无关。(C)2013爱思唯尔有限公司版权所有。
Despite its success, Medicare Part D has been widely criticized for the gap in coverage, the so-called "doughnut hole". We compare the use of prescription drugs among beneficiaries subject to the coverage gap with usage among beneficiaries who are not exposed to it. We find that the coverage gap does, indeed, disrupt the use of prescription drugs among seniors with diabetes. But the declines in usage are modest and concentrated among higher cost, brand-name medications. Demand for high cost medications such as antipsychotics, antiasthmatics, and drugs of the central nervous system decline by 8-18% in the coverage gap, while use of lower cost medications with high generic penetration such as beta blockers, ACE inhibitors and antidepressants decline by 3-5% after reaching the gap. More importantly, lower adherence to medications is not associated with increases in medical service use. (C) 2013 Elsevier B.V. All rights reserved.