The Anticipatory Effects of Medicare Part D on Drug Utilization

医疗保险 D 部分对药物利用的预期影响

• 批准号: 8020670
• 负责人: Abby Elizabeth Alpert
• 金额: $ 3.18万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8020670
• 关键词: Anticipatory; Effects; Medicare; Part; Drug

DESCRIPTION (provided by applicant): In 2003, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was signed into law, which expanded the Medicare program to include voluntary insurance coverage for prescription drugs. This program, known as Part D, was implemented on January 1, 2006. Given that one of the program's primary aims was to expand access to prescription drugs, evaluating the impact on drug utilization is of first-order importance. However, identifying this effect is complicated by the fact that Part D was announced with the passage of the MMA in December 2003, two years before the program was implemented. Forward looking individuals may have anticipated future price changes brought about by subsidized coverage and changed their drug spending before Part D took effect. This project will estimate the causal demand response to the announcement of Part D in 2003. There are three implications of this project. First, this investigation quantifies the effect of announcing a policy before its implementation, with consequences for program evaluation. The idea that policy announcements can have real effects (separate from their implementation effect) on important outcomes has been largely unexplored in the program evaluation literature. Second, the project provides the first test of forward-looking behavior in the context of drug demand. In many other contexts, optimizing individuals trade-off present and future consumption based on the relative prices in each period. However, it is not known whether individuals are responsive to expectations of future prices when determining current drug consumption levels. Third, the project identifies a potentially large source of bias in the previous estimates of the utilization effect of Part D. To the extent that there was an anticipatory response, these studies- which identify the program effect from changes in utilization relative to the year or two just prior to the policy's implementation-- will misstate the net effect of Part D. The empirical approach identifies whether there is a causal anticipatory response by comparing utilization for chronic drugs relative to acute drugs before and after the announcement of Part D. This strategy hinges on the observation that acute drugs treat illnesses that are largely unpredictable, thus their demand is likely to respond only to current prices, whereas chronic drug use may respond negatively or positively to anticipated future price reductions. This project also uses variation in exposure to the announcement across other groups such as the elderly and near-elderly to identify the effect. Finally, this project produces the first treatment effect utilization estimates of Part D that take into account a pre-program anticipatory response. PUBLIC HEALTH RELEVANCE: This project seeks to estimate the causal anticipatory effects of Part D on drug utilization. Estimating the utilization effect of Part D is important for evaluating whether the primary aims of the policy-- expanding access to prescription drugs-- were achieved and for assessing the program's future financial solvency. Accounting for the combined effect of the anticipatory response and the response at implementation will produce a more accurate estimate of the program effect than previous studies that have considered the implementation effect alone.

描述（由申请人提供）：2003 年，《医疗保险处方药改进和现代化法案》(MMA) 签署成为法律，该法案扩大了医疗保险计划，将处方药的自愿保险范围纳入其中。该计划称为 D 部分，于 2006 年 1 月 1 日实施。鉴于该计划的主要目标之一是扩大处方药的获取范围，因此评估对药物利用的影响至关重要。然而，由于 D 部分是在 2003 年 12 月（即该计划实施前两年）通过 MMA 时宣布的，因此确定这种影响变得复杂。具有前瞻性的个人可能已经预见到补贴范围带来的未来价格变化，并在 D 部分生效之前改变了他们的药品支出。该项目将估计 2003 年 D 部分公告的因果需求响应。该项目有三个影响。首先，这项调查量化了政策实施前宣布的效果，以及项目评估的后果。政策公告可以对重要成果产生真正的影响（与其实施效果无关），这一观点在计划评估文献中很大程度上尚未得到探讨。其次，该项目首次测试了毒品需求背景下的前瞻性行为。在许多其他情况下，优化个人会根据每个时期的相对价格权衡当前和未来的消费。然而，尚不清楚个人在确定当前药物消费水平时是否会对未来价格的预期做出反应。第三，该项目发现了之前对 D 部分使用效果的估计中潜在的巨大偏差来源。就存在预期反应而言，这些研究（通过相对于政策实施前一两年的使用变化来确定计划效果）将错误地表述 D 部分的净效果。经验方法通过比较慢性药物相对于急性药物前后的使用情况来确定是否存在因果预期反应。 D 部分的公告。该策略取决于这样的观察：急性药物治疗的疾病在很大程度上是不可预测的，因此它们的需求可能仅对当前价格做出反应，而慢性药物的使用可能对预期的未来价格下降做出消极或积极的反应。该项目还利用其他群体（例如老年人和近老年人）对公告的接触程度的变化来确定效果。最后，该项目产生了 D 部分的第一个治疗效果利用估计，其中考虑了计划前的预期反应。 公共卫生相关性：该项目旨在估计 D 部分对药物利用的因果预期影响。估计 D 部分的利用效果对于评估该政策的主要目标（扩大处方药的获取）是否实现以及评估该计划未来的财务偿付能力非常重要。与之前单独考虑实施效果的研究相比，考虑预期反应和实施反应的综合效应将产生更准确的计划效果估计。