EFFECT OF MEDICAID DRUG COPAYMENTS ON OUTCOMES AND COSTS

处方药共付额是否真的会导致医疗补助受益人更高的医疗服务利用率和成本？在过去的十年里，州医疗补助计划中的处方药支出以远远超过通货膨胀的速度增长。 建立处方药共同支付制度是各州实施的一项成本控制战略，研究表明，受益人分担成本导致处方药使用率下降。不太清楚的是，共同支付对利用其他“替代”医疗服务，如住院、门诊和医生服务以及长期护理的影响。目前还不清楚各州是否真的在省钱，因为这些替代医疗服务的医疗补助额外成本可能超过自付费用节省的药物成本。本研究旨在回答以下问题：* 药物共同负担对参加医疗补助的人员的处方药使用有何影响？* 处方药的共同负担费用与医疗补助受益人使用其他医疗服务之间有何关联？* 处方药共同支付与州医疗补助计划的净成本节省有关吗？本研究将使用来自卫生保健融资管理局（HCFA）的州医疗补助研究文件和医疗保险文件的两年管理数据，以评估药物共付额对密苏里州和明尼苏达州充血性心力衰竭医疗补助受益人的影响。多元分析技术将被用来分析药物和其他卫生服务的利用和支出的变化。研究结果将帮助各州评估其医疗补助计划中药物共同支付政策的成本和收益。

Do prescription drug copayments actually lead to higher health services utilization and costs for Medicaid beneficiaries? Prescription drug expenditures in state Medicaid programs have risen at rates far in excess of inflation during the past decade. Instituting copayments for prescription drugs has been a cost-containment strategy implemented by states, and studies suggest that beneficiary cost sharing has led to a decrease in prescription drug utilization. What is less clear is the effect of copayments on utilization of other "substitute" medical services, such as hospitalization, outpatient and physician services, and long-term care. It is also unclear if states are really saving money because the additional cost to Medicaid for these substitute medical services may exceed the drug cost savings from copayments. This study is designed to answer the following questions: * What is the impact of a drug copayment on prescription drug utilization for persons enrolled in Medicaid? * What is the association between a copayment for prescription drugs and the utilization of other medical services by Medicaid beneficiaries? * Are prescription drug copayments related to a net cost savings for a state's Medicaid program? This study will use two years of administrative data from the Health Care Financing Administration'S (HCFA's) State Medicaid Research Files and Medicare Files to evaluate the impact of drug copayments on Missouri and Minnesota Medicaid beneficiaries with congestive heart failure. Multivariate analytic techniques will be used to analyze the variation in drug and other health services utilization and expenditures. The study findings will help states assess the costs and benefits of a drug copayment policy in their Medicaid programs.