在实施医疗保险D部分后,与成本相关的药物不服药和基本需求支出
Jeanne M Madden1, Amy J Graves, Fang Zhang
1Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, Massachusetts 02215, USA. jeanne_madden@hms.harvard.edu
JAMA
|April 24, 2008
概括
医疗保险D部分的实施导致了与成本相关的药物不服药 (CRN) 和放弃基本需求的显着减少. 然而,最患病的受益人没有看到CRN净减少.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 老年医学 老年医学
背景情况:
- 与成本相关的药物不服药 (CRN) 对美国的老年人和残疾人产生重大影响.
- 医疗保险处方药保险 (D部分) 对CRN的影响在很大程度上是未知的.
研究的目的:
- 评估医疗保险D部分对CRN的影响以及放弃基本需求购买药物的做法.
- 在实施D部分之前和之后量化这些行为中的变化.
主要方法:
- 一个人口水平的研究设计比较了2005年和2006年之间的结果 (D部分之前和之后) 与历史变化 (2004-2005).
- 利用了来自医疗保险当前受益者调查 (n=24,234) 的数据,这是一个全国代表性的样本.
- 使用后勤回归,控制人口统计,健康状况和历史趋势.
主要成果:
- 整体CRN患病率从2005年的14.1%下降到2006年的11.5%.
- 对基本需求的支出减少,从2005年的11.1%下降到2006年的7.6%.
- 观察到CRN和基本需求的显著减少,特别是在健康状况良好或良好的受益人中. 然而,健康状况不佳的受益人没有显示CRN显著下降.
结论:
- 医疗保险D部分的实施与CRN的适度但显著的减少和放弃基本需求有关.
- 重要的是,最生病的受益人 (健康状况不佳) 没有经历CRN的净下降,这突显了持续存在的挑战.
- 可能需要进一步的干预措施来解决弱势,高需要的医疗保险受益人中的CRN.
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