Impact of Medicare Part D on Racial Disparities in Diabetes Treatment and Outcome

医疗保险 D 部分对糖尿病治疗和结果中种族差异的影响

• 批准号: 7938793
• 负责人: JULIE Marie DONOHUE
• 金额: $ 23.27万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938793
• 关键词: Impact; Medicare; Part; Racial; Disparities

DESCRIPTION (provided by applicant): Many older adults respond to high out-of-pocket drug costs by skipping, reducing dosages of or not filling prescriptions for their medications. A primary goal of the new Medicare drug benefit (Part D) was to increase the availability of drug coverage and thereby improve medication use among older adults. Medicare Part D may have a disproportionate impact on medication use among beneficiaries in minority groups. For instance, African American beneficiaries have enrolled in Part D in greater numbers (62% vs. 48%) than Caucasian beneficiaries. Moreover, African American beneficiaries are more likely than Caucasian beneficiaries to qualify for generous Part D low-income subsidies. As a result, Part D may help to alleviate racial/ethnic disparities in clinical processes of care and health outcomes that have been documented for a range of chronic conditions among older adults. We will assess the impact of Part D on racial disparities in medication use and health outcomes for older adults with diabetes, a chronic condition with increasing prevalence. Given the worse glycemic control and higher diabetes-related mortality among African Americans compared to Caucasians, our proposed investigations have critical implications for health disparities. The long-term objective of our proposed study is to reduce racial/ethnic disparities in health by examining the impact of changes in insurance coverage among the elderly. This proposal has two primary objectives. First, we will assess racial differences in antidiabetic medication use, glycemic control, and diabetes-related hospitalizations and mortality for an elderly cohort with diabetes before the implementation of Part D. We hypothesize that older African American beneficiaries with diabetes will have lower levels of antidiabetic medication use, worse glycemic control, and higher diabetes-related hospitalization and mortality rates compared to Caucasian beneficiaries. Second, we will examine whether Part D mitigates racial disparities in medication use, glycemic control, and diabetes-related hospitalizations and mortality in the elderly. We hypothesize that older African Americans compared to Caucasians will experience a larger improvement in medication use, glycemic control, and diabetes-related hospitalizations and mortality. Our study will use longitudinal data from an 11-year, Medicare population-based prospective cohort study. We will adjust our estimates of the effect of race and Part D for socioeconomic status, comorbidities, health, functional and cognitive status, access to care, and other factors. Our research has important policy implications. Medicare Part D -- the most substantial expansion of insurance benefits to older adults since the program's inception over 40 years ago -- is projected to cost just under $1 trillion between 2007 and 2017. If Medicare Part D reduces racial disparities in medication access, our study will inform other efforts to expand insurance coverage to vulnerable populations. Our multidisciplinary research team has extensive experience conducting health policy analyses, pharmacoepidemiologic studies with geriatric populations, health disparities and diabetes research, and is uniquely positioned to shed light on this critical policy issue.

描述（由申请人提供）：许多老年人对高自付药费的反应是跳过、减少剂量或不按处方服药。新的医疗保险药物福利（D部分）的主要目标是增加药物覆盖的可获得性，从而改善老年人的药物使用。医疗保险D部分可能对少数群体受益人的药物使用产生不成比例的影响。例如，非裔美国人受益人参加D部分的人数多于白人受益人（62%对48%）。此外，非裔美国人受益人比白人受益人更有可能有资格获得D部分慷慨的低收入补贴。因此，D部分可能有助于缓解已记录的一系列慢性病的临床护理过程和健康结果中的种族/民族差异