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Impact of Medicare Part D on Cancer and Diabetes Disparities among Dual Enrollees

医疗保险 D 部分对双重参保者中癌症和糖尿病差异的影响

基本信息

批准号：
8119583
负责人：
Alyce Sophia Adams
金额：
$ 45.23万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2013-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8119583
关键词：
Accident and Emergency department Accounting Address Adherence Age Analgesics Antidepressive Agents Asians California Cancer Patient Cardiovascular Agents Cardiovascular system Caring Characteristics Chronic Disease Chronically Ill Comorbidity Diabetes Mellitus Diagnostic Neoplasm Staging Disabled Persons Disease Management Documentation Dose Drug Prescriptions Education Elderly English Language Enrollment Ethnic Origin Evaluation Event Excision Experimental Designs Gender Goals Health Health Services Health Status Heart Diseases Hispanics Hospitalization Hospitals Income Insulin Insurance Insurance Coverage Linear Models Lung diseases Malignant Neoplasms Mediating Mediator of activation protein Medicaid Medicare Medicare/Medicaid Medicine Mental disorders Minority Groups Missouri Myocardial Infarction National Health Insurance Nausea Neighborhoods New Jersey Newly Diagnosed Outcome Patients Persons Pharmaceutical Preparations Policies Provider Race Randomized Relative (related person)Reporting Research Series Severity of illness Socioeconomic Status Source South Carolina Stroke Subgroup Survival Analysis Time Time Series Analysis Variant Visit cancer therapy chemotherapy cohort cost effective therapy experience health disparity high risk nursing home length of stay programs racial and ethnic disparities racial/ethnic difference research study response severe mental illness trend

项目摘要

DESCRIPTION (provided by applicant): Impact of Medicare Part D on Cancer and Diabetes Disparities among Dual Enrollees Despite the availability of effective therapies to treat chronic disease, disparities in the use of these medicines persist. Racial and ethnic minorities are disproportionately represented among the more than 7 million dual Medicaid and Medicare enrollees, who were transitioned from Medicaid to Medicare Part D drug coverage plans on January 1, 2006. Concerns have been raised about the random assignment of dual enrollees to Part D plans, due to varying benefits and reported declines in coverage. Few studies have examined the impact of coverage policy on disparities in medication use and related health outcomes. The implementation of Medicare Part D offers a unique opportunity to investigate the consequences of a major change in national coverage policy on health disparities. Our application focuses on two principal mechanisms by which Medicare Part D may impact health disparities among dual enrollees: 1) the removal of limits on the number of reimbursable prescriptions per month and 2) randomization of enrollees to plans with varying availability of medications for chronic disease management. The removal of prescription drug limits in some states may reduce gaps in medication use and, for high risk subgroups, access-related disparities in outcomes. For dual enrollees in all states, the ability to navigate Part D related changes in benefits (i.e., medication accessibility) may be mediated through patient (e.g., English language proficiency, education, usual source of care) and care setting characteristics that interact with race and ethnicity. Taking advantage of the random assignment of dual enrollees to Part D plans, we will use a strong quasi-experimental and an experimental design to investigate the impact of Medicare Part D drug coverage on racial and ethnic disparities among dual enrollees overall and among high risk chronically ill subgroups. Because of variation in Medicaid and in Part D plan benefits, each state represents a separate natural policy experiment. The goal of this study is to move beyond the documentation of health disparities to understanding the impact of coverage policy on disparities and potential mediating factors. PUBLIC HEALTH RELEVANCE: Impact of Medicare Part D on Cancer and Diabetes Disparities among Dual Enrollees Access to appropriate health care services is a key driver of differences in health services use and outcomes by race and ethnicity. However, few studies have evaluated the impact of changes in public insurance programs (e.g., Medicaid, Medicare) on health disparities. The purpose of this study is to investigate the impact of a major change in national health insurance coverage (the passage of Medicare Part D) on disparities in health services use, outcomes and costs among vulnerable chronically ill patients.

描述（由申请人提供）：医疗保险D部分对双重登记者中癌症和糖尿病差异的影响尽管有治疗慢性病的有效疗法，但这些药物的使用仍然存在差异。在2006年1月1日从医疗补助计划过渡到医疗保险D部分药物覆盖计划的700多万双重医疗补助和医疗保险登记者中，种族和少数民族的比例不成比例。由于不同的福利和报道的覆盖率下降，人们对随机分配双重登记者参加D部分计划表示关切。很少有研究探讨了覆盖政策对药物使用和相关健康结果差异的影响。医疗保险D部分的实施提供了一个独特的机会，调查国家覆盖政策的重大变化对健康差距的影响。我们的应用程序集中在两个主要机制，医疗保险D部分可能会影响双重登记者之间的健康差异：1）取消每月可报销处方数量的限制，2）将登记者随机分配到具有不同可用药物的计划，用于慢性病管理。在某些州取消处方药限制可能会减少药物使用方面的差距，对于高风险亚组，可能会减少与获得相关的结果差异。对于所有州的双重登记者，导航D部分相关福利变化的能力（即，药物可及性）可以通过患者（例如，英语语言能力、教育、通常的护理来源）以及与种族和民族相互作用的护理环境特征。利用随机分配的双重登记D部分计划，我们将使用一个强有力的准实验和实验设计，以调查医疗保险D部分药物覆盖的影响种族和民族之间的差异双重登记的整体和高风险的慢性病亚组。由于医疗补助和D部分计划福利的差异，每个州都代表了一个单独的自然政策实验。本研究的目标是超越文件的健康差距，了解覆盖政策的差异和潜在的中介因素的影响。公共卫生相关性：医疗保险D部分对癌症和糖尿病差异的影响双重登记者获得适当的医疗保健服务是种族和民族在医疗服务使用和结果方面差异的关键驱动因素。然而，很少有研究评估公共保险计划变化的影响（例如，医疗补助，医疗保险）的健康差距。本研究的目的是调查国家健康保险覆盖范围的重大变化（医疗保险D部分的通过）对弱势慢性病患者的医疗服务使用，结果和成本差异的影响。