权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Racial and Ethnic Differences in Response to the Medicare Coverage Gap among Pati

帕蒂人对医疗保险覆盖差距的反应存在种族和民族差异

基本信息

批准号：
8244954
负责人：
Yuting Zhang
金额：
$ 30.17万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-01 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8244954
关键词：
Racial Ethnic Differences Response Medicare

项目摘要

DESCRIPTION (provided by the applicant): A controversial component of Medicare Part D is the coverage gap for prescription expenditures between $2,400 and $5,451. A Kaiser Family Foundation study reported that 15% of Part D enrollees stopped their cardiac medications after reaching the coverage gap, but only about 40% reinitiated medication treatment after drug coverage resumed. Cost-related medication non-adherence can worsen health outcomes, increase rates of hospitalization and overall medical care spending. We believe black/Hispanic Medicare beneficiaries with congestive heart failure (CHF) and/or a recent history of acute myocardial infarction (MI) will likely be affected severely by the coverage gap, but no research has done in this important area. We propose to study whether the coverage gap affects black/Hispanic beneficiaries with CHF/MI more severely than non-Hispanic white beneficiaries, using merged national 2007-2008 Medicare pharmacy and medical claims data. We hypothesize that compared with non-Hispanic whites, after adjusting for socio-demographic and health status, black/Hispanic beneficiaries are more likely to reduce cardiovascular medication use due to the coverage gap and less likely and/or slower to reinitiate medications after discontinuation when drug coverage resumes. Therefore we hypothesize that black/Hispanic patients exposed to the coverage gap will have higher rates of hospitalization and higher non-drug medical costs than do non-Hispanic whites, after adjusting for socio-demographic and health status. Our research team has been at the forefront in Part D related research: our Health Affairs study is one of the first papers to evaluate the effects of the coverage gap on medication use and our NEJM study is the first to demonstrate the offset effects of Part D drug coverage on non-drug medical spending. Little evidence exists on how patients with cardiac diseases respond to the Part D coverage gap, how these responses vary by race/ethnicity. Our study will fill this knowledge gap, by providing critical evidence to policymakers who could potentially redesign Part D benefits or to clinicians who could proactively work with the struggling vulnerable population to improve their health outcomes. PUBLIC HEALTH RELEVANCE: A controversial component of Medicare Part D is the coverage gap for prescription expenditures between $2,400 and $5,451. Black/Hispanic minority beneficiaries with cardiac diseases might be affected most severely by the coverage gap, because almost half of them will reach the coverage gap and will reduce their medication use due to high drug costs. Cost-related medication non-adherence worsens health outcomes, and increased rates of hospitalization and total medical costs. Our proposed study would be the first national study to examine whether the coverage gap affects Black/Hispanic beneficiaries with cardiac diseases more than non-Hispanic white beneficiaries, using merged national 2007-2008 Medicare pharmacy and medical claims data. .

描述（由申请人提供）：医疗保险D部分的一个有争议的组成部分是处方支出在2,400美元和5451美元之间的覆盖缺口。凯撒家庭基金会的一项研究报告说，15%的D部分登记者在达到覆盖范围缺口后停止了心脏药物治疗，但只有大约40%的人在药物覆盖范围恢复后重新开始药物治疗。与成本相关的药物不依从性会恶化健康结果，增加住院率和整体医疗保健支出。我们认为，患有充血性心力衰竭（CHF）和/或近期急性心肌梗死（MI）病史的黑人/西班牙裔医疗保险受益人可能会受到覆盖缺口的严重影响，但在这一重要领域还没有研究。我们建议使用合并的2007-2008年全国医疗保险药房和医疗索赔数据，研究覆盖率差距是否对CHF/MI的黑人/西班牙裔受益人的影响比非西班牙裔白色受益人更严重。我们假设，与非西班牙裔白人相比，在调整社会人口统计学和健康状况后，黑人/西班牙裔受益人更有可能减少心血管药物的使用，因为覆盖范围的差距，并且在药物覆盖范围恢复时，在停药后重新开始药物治疗的可能性较小和/或较慢。因此，我们假设，在调整社会人口统计学和健康状况后，暴露于覆盖缺口的黑人/西班牙裔患者的住院率和非药物医疗费用高于非西班牙裔白人。我们的研究团队一直处于D部分相关研究的最前沿：我们的卫生事务研究是第一批评估覆盖差距对药物使用影响的论文之一，我们的NEJM研究是第一个证明D部分药物覆盖对非药物医疗支出的抵消作用的论文。几乎没有证据表明心脏病患者如何应对D部分覆盖范围的差距，这些反应如何因种族/民族而异。我们的研究将填补这一知识空白，为可能重新设计D部分福利的政策制定者或可以积极与挣扎中的弱势群体合作以改善其健康结果的临床医生提供关键证据。公共卫生相关性：医疗保险D部分的一个有争议的组成部分是处方支出在2,400美元和5451美元之间的覆盖范围。患有心脏病的黑人/西班牙裔少数族裔受益人可能受到覆盖率差距的影响最严重，因为他们中几乎有一半人将达到覆盖率差距，并将由于高昂的药物费用而减少药物使用。与费用相关的药物不依从性影响健康结果，并增加住院率和总医疗费用。我们提出的研究将是第一个全国性的研究，以检查是否覆盖差距影响黑人/西班牙裔受益人心脏病超过非西班牙裔白色受益人，使用合并的国家2007-2008年医疗保险药房和医疗索赔数据。 .