Response to Medicare Reimbursement Policy Change by Minority and All ESRD Patient

描述(由申请人提供)：根据疾病流行率、确诊的终末期肾病患者接受移植的机会和健康结果，非裔美国人和拉美裔美国人受到终末期肾病(ESRD)的影响不成比例。1972年的社会保障修正案赋予美国几乎所有终末期肾病患者接受医疗保险资助的肾脏移植的权利，但将移植后护理的覆盖范围限制为1年。随着时间的推移，移植后的保险范围扩大到3年，最终在2000年12月，《受益人改进和保护法》(BIPA 2000)为符合年龄或非ESRD残疾的医疗保险受益人提供了扩大移植后保险范围的机会。在少数族裔中，用于移植后护理的昂贵的抗排斥药物缺乏补充保险的比例更高，这在一定程度上解释了为什么非洲裔美国人和其他少数族裔的移植比率历来低于非西语裔白人。将根据最近的USRDS标准分析文件(SAF)开发差异模型，以比较两组符合联邦医疗保险资格的人：第一组，老年人(年龄=65岁)和/或非ESRD残疾人，他们受到联邦医疗保险法变化的影响；第二组，非老年人(年龄=65岁)，他们只有ESRD，不受联邦医疗保险法变化的影响。由于BIPA 2000旨在减轻患者与移植后免疫抑制药物相关的经济负担，这项法律的通过将不成比例地(积极)影响经济困难人群的肾移植等候名单和实际肾移植的比率，其中许多人是少数族裔。这项研究将使未来的卫生政策制定者了解国会有能力改善我国日益增长的ESRD人口的公共健康，并减少种族和民族健康差距。公共卫生相关性：本申请中提出的研究将探索对《受益人改进和保护法》(BIPA 2000)通过后的反应，该法案涉及肾移植的总体比率和肾移植等待名单上的置入率。BIPA 2000为扩大移植后免疫抑制药物的医疗保险范围提供了机会；如果终末期肾病患者对此作出回应，那么BIPA 2000的通过将对所有ESRD患者的移植比率产生积极影响，特别是那些经济上处于不利地位的亚群。不幸的是，由于少数族裔在这一经济上处于不利地位的群体中不成比例，我们建议测试这一政策变化是否对少数族裔产生积极影响，并有助于减少移植比率中的种族和民族差异。

DESCRIPTION (provided by applicant): African Americans and Hispanics are disproportionately impacted by end-stage renal disease (ESRD) based upon disease prevalence, access to transplantation among diagnosed ESRD patients, and health outcomes. The Social Security Amendments of 1972 entitled almost all patients with ESRD in the United States to Medicare-funded renal transplantation, but limited coverage of post-transplant care to 1 year. Over time, post-transplant coverage was extended to 3 years and eventually in December of 2000, the Beneficiary Improvements and Protection Act (BIPA 2000) provided an opportunity for extended post-transplant coverage for Medicare beneficiaries whose eligibility was based on age or non-ESRD disability. Lack of supplementary coverage for the expensive anti-rejection drugs that are used for post-transplant care is higher among minorities, which partially explains why African Americans and other minorities historically have had lower rates of transplantation than non-Hispanic whites. A difference-in- difference model will be developed based upon recent USRDS standard analysis files (SAF) to compare two sets of Medicare eligible: the first, Seniors (Age >= 65) and/or non-ESRD disabled, who are affected by the changes in the Medicare Law, and the second, Non-seniors (Age < 65) who only have ESRD, and are unaffected by the changes in the Medicare Law. Since BIPA 2000 was intended to reduce the patient's financial burden associated with post-transplant immunosuppressant drugs, passage of this law should disproportionately (positively) impact the rates of placement on the wait list for renal transplant and actual renal transplantation for the financially disadvantaged population, many of whom are minorities. This research will inform future health policy makers regarding the Congress' ability to improve the public health of our nation's growing ESRD population and reduce racial and ethnic health disparities. PUBLIC HEALTH RELEVANCE: The research proposed in this application will explore the response to the passage of the Beneficiary Improvements and Protection Act (BIPA 2000) on the overall rate of renal transplantation, and the rate of placement on the renal transplantation waitlist. BIPA 2000 provided an opportunity for extended Medicare coverage for post-transplantation immunosuppressant drugs; if patients with ESRD responded to this, then passage of BIPA 2000 should positively affect the rates of transplantation for all patients with ESRD but particularly those sub-populations who are financially disadvantaged. Since, unfortunately, minorities are disproportionately among this financially disadvantaged group, we propose to test whether this policy change positively affects minorities and contributes towards the reduction in racial and ethnic disparities in the transplantation rates.