The impact of Medicare Part D on out-of-pocket costs for prescription drugs, medication utilization, health resource utilization, and preference-based health utility.
ABSTRACT To quantify the impact of Medicare Part D eligibility on medication utilization, emergency department use, hospitalization, and preference-based health utility among civilian noninstitutionalized Medicare beneficiaries.
Difference-in-differences analyses were used to estimate the effects of Part D eligibility on health outcomes by comparing a 12-month period before and after Part D implementation using the Medical Expenditure Panel Survey. Models adjusted for sociodemographic characteristics and health status and compared Medicare beneficiaries aged 65 and older with near elderly aged 55-63 years old.
Five hundred and fifty-six elderly and 549 near elderly were included. After adjustment, Part D was associated with a U.S.$179.86 (p=.034) reduction in out-of-pocket costs and an increase of 2.05 prescriptions (p=.081) per patient year. The associations between Part D and emergency department use, hospitalizations, and preference-based health utility did not suggest cost offsets and were not statistically significant.
Although there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries during the first year after Part D, there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D during its first year of implementation.
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ABSTRACT: The aim of this study is to evaluate whether Medicare Part D reduced racial/ethnic disparities in hospital utilization among Medicare seniors, based on the Institute of Medicine's definition of a disparity. Using data on 43,098 adult respondents to the 2002-2009 Medical Expenditure Panel Survey, we derive a difference-in-difference-in-differences estimator using a multivariate regression framework, and measure Part D's effects on disparities in any hospitalization, the number of nights hospitalized, and inpatient expenses. Part D narrowed racial/ethnic disparities in hospital utilization. For African Americans, it reduced the disparity in any hospitalization by 2.94% (p < .001) but had no effect on disparities in nights hospitalized or inpatient expenses. For Hispanics, Part D reduced disparities in nights hospitalized by 1.58 nights (p = .009) and in inpatient expenses by US$3,453 (p < .001). Following Medicare Part D, disparities in hospital utilization narrowed significantly for both African American and Hispanic seniors, but in different ways for each population. © The Author(s) 2015.Journal of aging and health. 02/2015;
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ABSTRACT: Medicare Part D was designed to reduce out-of-pocket (OOP) costs for Medicare beneficiaries, but to the authors' knowledge the extent to which this occurred for patients with cancer has not been measured to date. The objective of the current study was to examine the impact of Medicare Part D eligibility on OOP cost for prescription drugs and use of medical services among patients with cancer.Cancer 06/2014; · 4.90 Impact Factor
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ABSTRACT: Objectives: Determine whether the implementation of the Medicare Part D 2006 was associated with changes in differential racial and ethnic disparity patterns between the individuals ineligible for medication therapy management (MTM) services and MTM-eligible individuals. The urgency for modifying MTM eligibility criteria would be increased if the reduction of disparity not seen. Methods: Data from the Medicare Current Beneficiary Survey were analyzed. A difference-in-differences analyses, difference-in-differences-in-differences-in-differences (DDDD) model, was used to examine changes in difference in disparities between the MTM-ineligible and MTM-eligible individuals from 2004-2005 to 2007-2008 in relation to the changes from 2001-2002 to 2004-2005. Disparities were examined in health outcomes, health services utilizations/costs, and medication utilization. Both main and sensitivity analyses were conducted by various regression models. Findings: The main analysis found no significant DDDD values. For racial disparities, according to some sensitivity analyses, Part D implementation was associated with a reduction in greater racial disparities among the MTM-ineligible and MTM-eligible individuals in activities of daily living (DDDD=1.13; P=0.03 for one analysis) and instrumental activities of daily living (DDDD=0.95; P=0.03 for one analysis). For ethnic disparities, Part D implementation was associated with reduction in any greater disparities among the MTM-ineligible than MTM-eligible individuals in costs of physician visits (DDDD=-4613.71; P=0.04 for one analysis) and high risk medication utilization (DDDD=-0.10; P=0.03 for one analysis). Conclusions: Part D implementation is not consistently associated with reductions in the disparity implications of the Medicare MTM eligibility criteria. The MTM eligibility criteria need to be modified in order to eliminate their disparity implications.142nd APHA Annual Meeting and Exposition 2014; 11/2014