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

描述（由申请人提供）：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尽管有治疗慢性疾病的有效疗法，但这些药物的使用差异仍然存在。在2006年1月1日从医疗补助计划过渡到医疗保险D部分药物保险计划的700多万双重医疗补助和医疗保险参保者中，种族和少数民族的比例过高。由于不同的福利和报道的覆盖率下降，双投保人随机分配到D部分计划引起了人们的关注。很少有研究审查覆盖政策对药物使用差异和相关健康结果的影响。医疗保险D部分的实施提供了一个独特的机会来调查国家保险政策重大变化对健康差异的影响。我们的应用着重于医疗保险D部分可能影响双重参保人健康差异的两个主要机制：1)取消每月可报销处方数量的限制；2)随机化参保人到慢性病管理药物可用性不同的计划中。在一些州取消处方药限制可能会减少药物使用方面的差距，对于高风险亚群体，可能会减少与可及性相关的结果差异。对于所有州的双重入组者，驾驭D部分相关福利变化（即药物可及性）的能力可能通过患者（如英语语言能力、教育、通常的护理来源）和与种族和民族相互作用的护理环境特征来调节。利用双入选者随机分配到D部分计划的优势，我们将使用强准实验和实验设计来调查医疗保险D部分药物覆盖对双入选者总体和高风险慢性疾病亚组之间种族和民族差异的影响。由于医疗补助计划和D部分计划的福利各不相同，每个州都代表着一个独立的自然政策实验。本研究的目的是超越对健康差异的记录，了解覆盖政策对差异的影响和潜在的中介因素。公共卫生相关性：医疗保险D部分对双重参保者癌症和糖尿病差异的影响获得适当的卫生保健服务是种族和民族卫生服务使用和结果差异的关键驱动因素。然而，很少有研究评估公共保险计划（例如，医疗补助，医疗保险）变化对健康差距的影响。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）对弱势慢性病患者在卫生服务使用、结果和成本方面的差异的影响。

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.