Response to Medicare Reimbursement Policy Change by Minority and All ESRD Patient

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DESCRIPTION (provided by applicant): African Americans and Hispanics are disproportionately impacted by end-stage renal disease (ESRD) based upon disease prevalence, access to transplantation among diagnosed ESRD patients, and health outcomes. The Social Security Amendments of 1972 entitled almost all patients with ESRD in the United States to Medicare-funded renal transplantation, but limited coverage of post-transplant care to 1 year. Over time, post-transplant coverage was extended to 3 years and eventually in December of 2000, the Beneficiary Improvements and Protection Act (BIPA 2000) provided an opportunity for extended post-transplant coverage for Medicare beneficiaries whose eligibility was based on age or non-ESRD disability. Lack of supplementary coverage for the expensive anti-rejection drugs that are used for post-transplant care is higher among minorities, which partially explains why African Americans and other minorities historically have had lower rates of transplantation than non-Hispanic whites. A difference-in- difference model will be developed based upon recent USRDS standard analysis files (SAF) to compare two sets of Medicare eligible: the first, Seniors (Age >= 65) and/or non-ESRD disabled, who are affected by the changes in the Medicare Law, and the second, Non-seniors (Age < 65) who only have ESRD, and are unaffected by the changes in the Medicare Law. Since BIPA 2000 was intended to reduce the patient's financial burden associated with post-transplant immunosuppressant drugs, passage of this law should disproportionately (positively) impact the rates of placement on the wait list for renal transplant and actual renal transplantation for the financially disadvantaged population, many of whom are minorities. This research will inform future health policy makers regarding the Congress' ability to improve the public health of our nation's growing ESRD population and reduce racial and ethnic health disparities. PUBLIC HEALTH RELEVANCE: The research proposed in this application will explore the response to the passage of the Beneficiary Improvements and Protection Act (BIPA 2000) on the overall rate of renal transplantation, and the rate of placement on the renal transplantation waitlist. BIPA 2000 provided an opportunity for extended Medicare coverage for post-transplantation immunosuppressant drugs; if patients with ESRD responded to this, then passage of BIPA 2000 should positively affect the rates of transplantation for all patients with ESRD but particularly those sub-populations who are financially disadvantaged. Since, unfortunately, minorities are disproportionately among this financially disadvantaged group, we propose to test whether this policy change positively affects minorities and contributes towards the reduction in racial and ethnic disparities in the transplantation rates.