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

描述（由申请人提供）：根据疾病患病率、确诊的终末期肾病患者接受移植的情况和健康结局，非裔美国人和西班牙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使美国几乎所有的终末期肾病患者都有权接受医疗保险资助的肾移植，但将移植后护理的覆盖范围限制为1年。随着时间的推移，移植后的覆盖范围扩大到3年，最终在2000年12月，《福利改善和保护法》（BIPA 2000）为医疗保险受益人提供了一个机会，扩大移植后的覆盖范围，其资格是基于年龄或非ESRD残疾。用于移植后护理的昂贵抗排斥药物的补充覆盖率在少数民族中更高，这部分解释了为什么非洲裔美国人和其他少数民族的移植率历史上低于非西班牙裔白人。将根据最近的USRDS标准分析文件（SAF）开发差异中的差异模型，以比较两组符合Medicare条件的患者：第一组是老年人（年龄>= 65岁）和/或非ESRD残疾人，他们受Medicare法律变化的影响，第二组是仅患有ESRD的非老年人（年龄< 65岁），不受Medicare法律变化的影响。由于《2000年肾脏移植法》的目的是减轻患者在移植后使用免疫抑制剂的经济负担，因此，该法的通过将对经济困难人群（其中许多人是少数民族）的肾移植等候名单和实际肾移植的安置率产生不成比例的（积极）影响。这项研究将告知未来的卫生政策制定者，国会有能力改善我国不断增长的ESRD人口的公共卫生，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讨对《福利改善和保护法》（BIPA 2000）通过的反应，即肾移植的总体比率和肾移植等待名单上的安置率。BIPA 2000为扩大移植后免疫抑制剂药物的医疗保险覆盖范围提供了机会;如果终末期肾病患者对此有反应，那么BIPA 2000的通过应该会对所有终末期肾病患者的移植率产生积极影响，特别是那些经济上处于不利地位的亚人群。由于不幸的是，少数民族在这个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民族产生积极影响，并有助于减少移植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.