Benefit Generosity, Specialty Drug Use, and Other Health Service Use in Medicare

医疗保险中的福利慷慨、特殊药物的使用和其他健康服务的使用

• 批准号: 8912968
• 负责人: Jeah Jung
• 金额: $ 26.21万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8912968
• 关键词: Accounting; Acute; Address; Admission activity; Affect; Ambulatory Care; Ambulatory Surgical Procedures; Attention; Autoimmune Diseases; Biotechnology; Caring; Complex; Cost Sharing; Data; Data Set; Disease; Drug Costs; Drug Prescriptions; Drug Utilization; Drug usage; Drug user; Effectiveness; Elderly; Ensure; Equilibrium; Face; Future; Generic Drugs; Genes; Health; Health Benefit; Health Care Costs; Health Services; Healthcare; Healthcare Systems; Inpatients; Insurance Carriers; Life; Literature; Malignant Neoplasms; Measures; Medicare; Methods; Names; Outpatients; Patients; Pattern; Pharmaceutical Preparations; Pharmacologic Substance; Physicians; Policies; Population; Price; Proteins; Quality of life; Research; Research Personnel; Sampling; Services; Symptoms; Therapeutic; Visit; age related; alternative treatment; beneficiary; cost; cost effective; design; financial incentive; health care service utilization; hospice environment; medical specialties; pressure; programs; tool; trend

DESCRIPTION (provided by applicant): Specialty drugs typically refer to high-cost biologic drugs used to treat serious and complex conditions. In many cases, they can offer life-extending or significant quality-of-life benefits to patients with conditions that have few alternative treatments. However, their prices are substantially higher than those of traditional pharmaceuticals, and their rapidly-rising costs are an important concern. Demand for specialty drugs is expected to increase dramatically as new drugs become available. Facing this alarming trend, payers and policy researchers are calling for urgent attention to develop strategies to effectively manage specialty drug use, recognizing that specialty drugs will be a major driver of future health care costs. Benefit design is commonly used to manage prescription drug utilization. Prior literature suggests that patient cost-sharing reduces prescription drug utilizaton. However, it is not clear whether similar approaches would be effective in managing specialty drug use because specialty drugs do not have generic substitutes or other therapeutic equivalents. Designing benefits for specialty drugs will involve tough choices because of the challenge of balancing patients' access with efforts to control health care costs. To address this challenge, it is essential to know how patients' use of specialty drugs responds to benefit generosity. Information on the value or effectiveness of specialty drug benefits is also needed. Yet, evidence on these issues is sparse. We propose to examine the impact of benefit generosity on the use of specialty drugs and other health care services among elderly Medicare beneficiaries. Using eight years of Medicare data from several files to which our research team has access, we will examine a comprehensive set of drug and other health service use measures, including (1) initiation of specialty drugs, (2) spending on specialty drugs, (3) hospita admissions, (4) outpatient facility use (e.g., outpatient surgery), (5) physician visits, (6) post-acute care use, (7) hospice service use, (8) total Part A/B costs, and (9) spending on Part B- covered drugs. Our proposed study leverages an exogenous change in the Part D benefit to identify the effect of cost-sharing on specialty drug and other health care use. This is a unique opportunity to address issues related to specialty drug use without encountering a possible endogeneity problem associated with specialty drug benefits. We will also assess how differences in specialty drug cost- sharing imposed by Part D plans affect specialty drug use. In this approach, we will use an instrumental variables (IV) method to address the potential endogeneity of specialty drug benefits. By examining the relations among drug benefit design, specialty drug use, and other health service utilization, our study will provide important information that could help guide policy discussions and explore benefit designs for specialty drugs.

描述（由申请人提供）：特殊药物通常是指用于治疗严重和复杂疾病的高成本生物药物。在许多情况下，它们可以为患有几乎没有替代治疗的疾病的患者提供延长寿命或显著的生活质量益处。然而，它们的价格大大高于传统药物，其迅速上涨的成本是一个重要的关切。随着新药的出现，对特种药物的需求预计将急剧增加。面对这一令人担忧的趋势，支付者和政策研究人员呼吁迫切关注制定有效管理特种药物使用的战略，认识到特种药物将成为未来医疗保健成本的主要驱动因素。福利设计通常用于管理处方药的使用。先前的文献表明，患者费用分摊降低了处方药的利用率。然而，目前尚不清楚类似的方法是否会有效地管理专业药物的使用，因为专业药物没有通用替代品或其他治疗等效物。为特殊药物设计福利将涉及坚韧的选择，因为在患者获得与控制医疗保健成本之间取得平衡是一项挑战。为了应对这一挑战，必须了解患者使用特殊药物如何应对慷慨的福利。还需要关于特殊药物益处的价值或有效性的信息。然而，关于这些问题的证据很少。我们建议研究老年医疗保险受益人中的特殊药物和其他医疗保健服务的使用福利慷慨的影响。使用我们的研究团队可以访问的几个文件中的八年医疗保险数据，我们将检查一套全面的药物和其他医疗服务使用措施，包括（1）开始使用特种药物，（2）特种药物支出，（3）住院，（4）门诊设施使用（例如，门诊手术）、（5）医生就诊、（6）急性期后护理使用、（7）临终关怀服务使用、（8）A/B部分总费用和（9）B部分承保药物的支出。我们提出的研究利用D部分获益的外源性变化来确定成本分摊对专科药物和其他医疗保健使用的影响。这是一个独特的机会，以解决与专业药物使用有关的问题，而不会遇到与专业药物利益相关的可能的内分泌问题。我们还将评估D部分计划规定的专科药物费用分摊的差异如何影响专科药物的使用。在这种方法中，我们将使用工具变量（IV）方法来解决特殊药物获益的潜在内分泌问题。通过研究药品福利设计、特殊药品使用和其他卫生服务利用之间的关系，我们的研究将提供重要信息，有助于指导政策讨论和探索特殊药品的福利设计。