Medicare Part D and Changes in Prescription Drug Use and Cost Burden National Estimates for the Medicare Population, 2000 to 2007
Medicare Part D and Changes in Prescription Drug Use and Cost Burden National Estimates for the Medicare Population, 2000 to 2007
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DOI：
10.1097/mlr.0b013e3182162afb
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发表时间：
2011-09-01
期刊：
影响因子：
3
通讯作者：
Soumerai, Stephen B.
中科院分区：
文献类型：
--
作者：
Briesacher, Becky A.;Zhao, Yanfang;Soumerai, Stephen B.
内容：在最初的政策过渡期后，医疗保险D部分的全部效果在美国医疗保险人群中仍然不清楚。目的：估计D部分实施后2年处方药使用和自付药物费用的全国代表性变化。设计，设置和参与者：我们检查了8年（2000年至2007年）的研究结果，并估计了D部分后的变化，解释了早期的趋势。我们的分析使用了医疗保险当前福利调查的社区流动样本（未加权的唯一n = 38，798）。将D部分后的实际结果与使用2000年至2005年数据的预测值进行了比较。亚组分析和标准化权重被用于解决人口水平的变化，随着时间的推移，在健康状况和人口统计学特征。主要结果测量：年度处方药填写和自付药物费用。我们观察到人均处方量显著增加1.8次[95%置信区间（CI），2006年为1.1-2.5]，2007年为3.4次处方配药（95% CI，2.7-4.1），高于D部分前每年0.9次处方配药的增长率。平均自付药物费用在2006年显著下降了143美元（95% CI，- 182.5- 103.1），在2007年下降了148美元（95% CI，- 181.2- 114.1），高于D部分前平均每年12美元的增长。健康状况一般至较差的受益人的处方配药情况没有改变，直到2007年出现大幅增加（比D部分前的趋势增加了3.7至11.0次配药）。OOP药物费用的显着减少发生在2006年，并坚持到2007年在所有群体中，除了病人和穷人的受益人没有Medicaid.Conclusions：2006年的过渡年后，D部分的影响似乎更大，更一致的医疗保险人口。值得注意的是，2007年，病人和贫困受益人的处方药使用情况有了显着改善。
Context: The full effect of Medicare Part D, after the initial policy transition period and across the United States Medicare population, remains unclear.Objective: To estimate nationally representative changes in prescription drug use and out-of-pocket drug costs 2 years after implementation of Part D.Design, Setting, and Participants: We examined study outcomes over 8 years (2000 to 2007) and estimated changes after Part D, accounting for earlier trends. Our analyses used the community-welling sample of the Medicare Current Beneficiary Survey (unweighted unique n = 38,798). Actual post-Part D outcomes were compared with projected values using 2000 to 2005 data. Subgroup analyses and standardization weights were used to address population-level shifts over time in health status and demographic characteristics.Main Outcome Measures: Annual prescription drug fills and out-of-pocket drug costs.Results: We observed significant average per person increases of 1.8 prescription fills [95% confidence interval (CI), 1.1-2.5] in 2006 and 3.4 prescription fills (95% CI, 2.7-4.1) in 2007 above pre-Part D increases of 0.9 prescription fills per year. Average out-of-pocket drug costs decreased significantly by $143 (95% CI, - 182.5- - 103.1) in 2006 and $148 (95% CI, - 181.2- - 114.1) in 2007 above average pre-Part D increases of $12 per year. Prescription fills did not change for beneficiaries with fair to poor health until 2007 when large increases occurred (increases of 3.7 to 11.0 fills above pre-Part D trends). Significant reductions in OOP drug costs occurred in 2006 and persisted into 2007 across all groups except for sick and poor beneficiaries without Medicaid.Conclusions: After the transition year of 2006, the impact of Part D seemed larger and more consistent across the Medicare population. Of note, sick and poor beneficiaries experienced significant improvements in prescription drug use in 2007.