Cost-Related Underuse of Medications in the Elderly

描述（由申请人提供）：自1965年医疗保险制定以来，该计划不包括门诊处方药物，医生提供的注射药物除外。现在人们普遍认识到，由于保险公司采取各种削减成本和转移成本的措施来应对日益增加的财政压力，老年人面临着处方福利的侵蚀。医疗保险受益人必须依靠一系列补充来源来帮助支付药费。医疗保险当前受益人调查（MCBS）每年对参加医疗保险的老年人和残疾成年人进行一次有代表性的全国抽样调查，代表了美国老年人处方保险费率和来源信息的黄金标准。然而，MCBS几乎没有提供与费用相关的不遵守药物方案的信息，也没有其他国家数据来源。虽然初步研究记录了自费药物费用、不遵医嘱率和不良临床结果之间的关系，但迄今为止还没有一项全国性研究表明，这些与费用相关的障碍是否会导致慢性疾病基本药物的使用不足、非处方药物或替代药物的替代，或医生就诊次数的减少。该项目将建立一个永久性的、持续的国家数据资源，使政策制定者和研究人员能够衡量、监测和确定老年医疗保险受益人中与费用相关的药物使用情况（CRUM）的变化。我们将制定新的综合措施；在一项大型健康计划中对大约200名老年参保人进行的调查中验证了这些措施；将这些措施纳入MCBS，对大约1.5万名非机构老年医疗保险参保人进行年度调查（其费用将由美国卫生与公众服务部医疗保险和医疗补助服务中心承担）；并分析MCBS数据，以确定CRUM与患者社会人口统计学、健康状况和医疗条件、处方覆盖来源和自付处方费用的关联程度。

DESCRIPTION (provided by applicant): Since Medicare was enacted in 1965, the program has excluded coverage for outpatient prescription medications except for injection drugs furnished by a physician. It is now widely recognized that the elderly face an erosion of prescription benefits as insurers respond to mounting fiscal pressures with a variety of cost-cutting and cost-shifting measures. Medicare beneficiaries must rely on a range of supplemental sources to help with drug expenses. The Medicare Current Beneficiary Survey (MCBS), administered annually to a representative national sample of elderly and disabled adults enrolled in Medicare, represents the gold standard for information on rates and sources of prescription coverage among elderly Americans. However the MCBS provides little information on cost-related non-compliance with medication regimens, and there are no other national data sources. While preliminary research documents the relationships among out-of-pocket medication costs, rates of non-compliance, and adverse clinical outcomes, no national study to date has addressed whether such cost-related barriers lead to under use of essential drugs for chronic illnesses, substitution of over-the-counter or alternative medicines, or reductions in physician visits. This project will establish a permanent, ongoing national data resource that permits policymakers and researchers to measure, monitor, and identify changes in cost-related under use of medications (CRUM) among elderly Medicare beneficiaries. We will develop new, comprehensive measures of CRUM; validate the measures in a survey of approximately 200 elderly enrollees in a large health plan; integrate the measures in the MCBS for annual surveys of approximately 15,000 non-institutionalized elderly Medicare enrollees (the cost of which will be borne by the US Department of Health and Human Services, Center for Medicare and Medicaid Services); and analyze MCBS data to identify the extent to which CRUM is associated with patient socio-demographics, health status and medical conditions, source of prescription coverage, and out-of-pocket prescription costs.