Does Part D Prescription Coverage Improve Health and Reduce Inpatient Use?

描述（由申请人提供）：我们的总体目标是提供可靠的证据，证明通过医疗保险D部分向老年人提供处方药保险是否降低了住院率和支出，并改善了受益人的健康。为了实现这一目标，我们将使用一种具有相当的外部和内部有效性的新方法。我们的方法利用了医疗保险当前受益人调查和健康与退休研究的数据，以确定老年人或多或少有可能通过D部分获得处方保险。然后，使用这些“治疗”和“比较”组，我们使用医疗保险提供者分析和审查（MEDPAR）数据，以获得通过D部分获得的处方药保险对住院服务和死亡率的使用和支出的影响估计。我们将使用由大部分组成的样本（例如，70%）的所有医疗保险受益人，这将导致一项研究具有无与伦比的外部效度。我们的研究得出的估计将 有助于填补评估Medicare全部成本和收益所需的知识空白 部分D.具体目的是估计获得Medicare Part D处方药保险与以下因素之间的关联：1）总体住院率以及急诊科和非急诊科的住院率; 2）与门诊处方药使用最相关的特定疾病的住院率，如门诊护理敏感性疾病; 3）年度住院费用（支出）和特定类型住院的年度住院费用，例如门诊护理敏感状况; 4）住院时间，使用服务（例如，手术次数）和与住院相关的费用，或因特定情况（如门诊护理敏感 条件;和5）受益人死亡率，以总死亡率和住院后死亡率衡量。

DESCRIPTION (provided by applicant): Our overall objective is to produce credible evidence regarding whether providing prescription drug insurance to the elderly through Medicare Part D has reduced inpatient hospitalization rates and spending and improved beneficiaries' health. To accomplish this objective we will use a novel method with considerable external and internal validity. Our method exploits data from the Medicare Current Beneficiary Survey and Health and Retirement Study to identify elderly more or less likely to gain prescription coverage through Part D. Then, using these "treatment" and "comparison" groups, we use the Medicare Provider Analysis and Review (MEDPAR) data to obtain estimates of the effect of prescription drug insurance obtained through Part D on use of, and spending on, inpatient services and mortality. We will use a sample consisting of a large portion (e.g., 70%) of all Medicare beneficiaries that will result in a study with unparalleled external validity. Estimates produced by our research will help fill a void in knowledge that is necessary to evaluate the full costs and benefits of Medicare Part D. The specific aim is to estimate associations between gaining Medicare Part D prescription drug insurance and: 1) overall rates of hospitalization and rates of hospitalization that do and do not originate in the Emergency Department; 2) hospitalization rates for specific conditions that are most plausibly linked to outpatient prescription drug use such as ambulatory care sensitive conditions; 3) annual inpatient charges (spending) and annual inpatient charges for specific types of inpatient admissions such as those for ambulatory care sensitive conditions; 4) length of stay, use of services (e.g., number of procedures) and charges associated with a hospitalization, or a hospitalization for a specific condition such as an ambulatory care sensitive condition; and 5) beneficiary mortality as measured by overall mortality and mortality following hospital admission.