补贴药物覆盖的损失和医疗保险受益人中的死亡率
Eric T Roberts1,2, Jessica Phelan3, Aaron L Schwartz1,2
1Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
The New England journal of medicine
|May 14, 2025
概括
失去低收入补贴 (LIS) 会增加低收入医疗保险受益人的死亡风险. 这项研究发现,在退出医疗补助计划后失去药物补贴与较高的死亡率有关.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年学是一门学科.
- 公共卫生政策 公共卫生政策
背景情况:
- 1400万名医疗保险受益者利用低收入者补贴 (LIS) 来降低医疗保险D部分的自付费用.
- 失去LIS可能会对药物坚持和患者健康结果产生负面影响,包括死亡率.
- 双重资格受益人自动获得LIS,但医疗补助退学可能会引发LIS损失.
研究的目的:
- 调查低收入补贴 (LIS) 损失与双重资格医疗保险受益人死亡率之间的关联.
- 检查医疗补助退学时间如何影响后续LIS损失及其对死亡率的影响.
主要方法:
- 利用2015-2023年的医疗保险数据来识别双重资格受益人.
- 早期 (一月至六月) 和晚期 (七月至十二月) 退出医疗补助计划的受益人之间的死亡率比较,分析LIS持续时间和退出医疗补助计划后17个月的累计死亡率.
- 利用基于医疗补助退学和随后的LIS损失的时间进行自然实验设计.
主要成果:
- 早期的医疗补助退学导致在17个月内获得LIS覆盖的月份较少 (13.6),而晚期退学 (15.3).
- 17个月后的累积死亡率在早期退学 (78.3/1000) 和晚期退学 (75.3/1000) 中较高,这是统计学上显著的差异.
- 与LIS损失相关的死亡风险增加在高部分D消费者和使用慢性疾病 (如心血管疾病,肺部疾病或艾滋病毒) 药物的个人中更为明显.
结论:
- 在退出医疗补助计划后,失去医疗保险D部分低收入补贴与低收入人群的死亡率增加有关.
- 政策影响表明,需要确保弱势医疗保险受益人持续获得处方药补贴.
- 这些发现强调了低收入人群支持计划,药物获取和长期健康结果之间的关键联系.
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