Impact of Medicare Part D on Cancer and Diabetes Disparities among Dual Enrollees

描述(由申请人提供)：联邦医疗保险D部分对癌症和糖尿病的影响尽管有治疗慢性病的有效疗法可用，但在使用这些药物方面仍然存在差异。在700多万双重医疗补助和医疗保险参与者中，种族和少数族裔的比例不成比例，这些人于2006年1月1日从医疗补助过渡到联邦医疗保险D部分药物覆盖计划。有人对随机分配双重投保人参加D部分计划表示关切，因为福利各不相同，而且据报道保险范围有所下降。很少有研究考察覆盖政策对药物使用差异和相关健康结果的影响。医疗保险D部分的实施提供了一个独特的机会，可以调查国家医疗保险政策对健康差距的重大变化所产生的后果。我们的应用集中在两个主要机制上，通过这些机制，Medicare Part D可能会影响双重参保人之间的健康差距：1)取消对每月可报销处方数量的限制，2)参保人随机参加慢性病管理药物供应不同的计划。在一些州取消处方药限制可能会减少用药差距，对于高风险亚群来说，可能会减少与结果相关的与获得有关的差异。对于所有州的双重投保人，导航D部分相关福利变化(即药物可获得性)的能力可能通过患者(例如，英语水平、教育程度、通常的护理来源)和与种族和民族互动的护理环境特征进行调节。利用双重参保人随机分配到D部分计划的优势，我们将使用强大的准实验和实验设计来调查联邦医疗保险D部分药物覆盖对双重参保人总体和高危慢性病亚群中种族和民族差异的影响。由于医疗补助和D部分计划福利的差异，每个州代表着一个单独的自然政策实验。这项研究的目标是超越对健康差距的记录，了解覆盖政策对差距的影响和潜在的中介因素。公共卫生相关性：《联邦医疗保险D部分》对双重参加人中癌症和糖尿病差异的影响获得适当的医疗保健服务是按种族和族裔划分的医疗服务使用和结果差异的一个关键驱动因素。然而，很少有研究评估公共保险计划(如医疗补助、医疗保险)的变化对健康差距的影响。这项研究的目的是调查国家医疗保险覆盖范围的重大变化(联邦医疗保险D部分的通过)对弱势慢性病患者在医疗服务使用、结果和费用方面的差异的影响。

DESCRIPTION (provided by applicant): Impact of Medicare Part D on Cancer and Diabetes Disparities among Dual Enrollees Despite the availability of effective therapies to treat chronic disease, disparities in the use of these medicines persist. Racial and ethnic minorities are disproportionately represented among the more than 7 million dual Medicaid and Medicare enrollees, who were transitioned from Medicaid to Medicare Part D drug coverage plans on January 1, 2006. Concerns have been raised about the random assignment of dual enrollees to Part D plans, due to varying benefits and reported declines in coverage. Few studies have examined the impact of coverage policy on disparities in medication use and related health outcomes. The implementation of Medicare Part D offers a unique opportunity to investigate the consequences of a major change in national coverage policy on health disparities. Our application focuses on two principal mechanisms by which Medicare Part D may impact health disparities among dual enrollees: 1) the removal of limits on the number of reimbursable prescriptions per month and 2) randomization of enrollees to plans with varying availability of medications for chronic disease management. The removal of prescription drug limits in some states may reduce gaps in medication use and, for high risk subgroups, access-related disparities in outcomes. For dual enrollees in all states, the ability to navigate Part D related changes in benefits (i.e., medication accessibility) may be mediated through patient (e.g., English language proficiency, education, usual source of care) and care setting characteristics that interact with race and ethnicity. Taking advantage of the random assignment of dual enrollees to Part D plans, we will use a strong quasi-experimental and an experimental design to investigate the impact of Medicare Part D drug coverage on racial and ethnic disparities among dual enrollees overall and among high risk chronically ill subgroups. Because of variation in Medicaid and in Part D plan benefits, each state represents a separate natural policy experiment. The goal of this study is to move beyond the documentation of health disparities to understanding the impact of coverage policy on disparities and potential mediating factors. PUBLIC HEALTH RELEVANCE: Impact of Medicare Part D on Cancer and Diabetes Disparities among Dual Enrollees Access to appropriate health care services is a key driver of differences in health services use and outcomes by race and ethnicity. However, few studies have evaluated the impact of changes in public insurance programs (e.g., Medicaid, Medicare) on health disparities. The purpose of this study is to investigate the impact of a major change in national health insurance coverage (the passage of Medicare Part D) on disparities in health services use, outcomes and costs among vulnerable chronically ill patients.