Access to the 340B Drug Pricing Program: is there evidence of strategic hospital behavior?
Access to the 340B Drug Pricing Program: is there evidence of strategic hospital behavior?
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DOI：
10.1186/s13104-021-05642-4
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发表时间：
2021-06-03
影响因子：
1.8
通讯作者：
Myerson R
中科院分区：
文献类型：
--
作者：
Mulligan K;Romley JA;Myerson R
340B药品定价计划允许医院以折扣价购买保险药品，如果这些药品的报销率超过340B的收购价格，就有可能产生利润。不成比例份额医院（DSH）有资格参加340B，如果他们的DSH调整-一种确定医院治疗不成比例份额的低收入医疗保险或医疗补助患者的措施-超过11.75%。为了评估医院是否采取了战略行动以获得该计划，我们检查了刚好高于340B资格的DSH调整阈值与低于DSH调整阈值的医院数量的数据，并进行了McCrary密度测试以评估统计意义。2014-2016年，医院数量增加了41%，刚好超过340B资格门槛。McCrary密度测试发现，2014-2016年，这种增长在不同带宽范围内具有统计学意义（p < 0.01）。从2011-2013年，研究结果对阈值附近的带宽敏感，但2008-2010年不显著。我们发现在不符合340B计划的医院中没有类似的变化。这些数据与一些医院调整DSH以获得340B资格的假设是一致的。我们的调查结果支持了政府问责局最近呼吁改善对340B计划的监督。
The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount and potentially generate profit if they are reimbursed at rates that exceed 340B acquisition prices. Disproportionate share hospitals (DSH) are eligible to participate in 340B if their DSH adjustment–a measure that identifies hospitals that treat a disproportionate share of low income Medicare or Medicaid patients–is above 11.75%. To assess whether hospitals behave strategically to gain access to the program, we examined data on the number of hospitals just above versus below the DSH adjustment threshold for 340B eligibility and conducted McCrary density tests to assess statistical significance. In 2014–2016, the number of hospitals increases by 41% just above the 340B eligibility threshold. McCrary density tests found this increase to be statistically significant across a range of bandwidths in 2014–2016 (p < 0.01). From 2011–2013, the findings are sensitive to the bandwidth around the threshold, but insignificant in 2008–2010. We found no comparable change among hospitals ineligible for the 340B program. These data are consistent with the hypothesis that some hospitals adjust their DSH to gain 340B eligibility. Our findings support recent calls from the Government Accountability Office to improve oversight of the 340B program.
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影响因子：
12.6
作者：
Lee, David S.;Lemieux, Thomas
通讯作者：
Lemieux, Thomas
影响因子：
5.8
作者：
Starc, Amanda;Town, Robert J.
通讯作者：
Town, Robert J.
影响因子：
10.7
作者：
Brown, Jason;Duggan, Mark;Woolston, William
通讯作者：
Woolston, William
影响因子：
5.8
作者：
Imbens, Guido;Kalyanaraman, Karthik
通讯作者：
Kalyanaraman, Karthik
DOI：
10.1056/nejmsa1706475
发表时间：
2018-02-08
期刊：
The New England journal of medicine
影响因子：
--
作者：
Desai S;McWilliams JM
通讯作者：
McWilliams JM