Medicare Part D is Associated With Reducing the Financial Burden of Health Care Services in Medicare Beneficiaries With Diagnosed Diabetes

*Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA †Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA.
Medical care (Impact Factor: 3.23). 08/2013; 51(10). DOI: 10.1097/MLR.0b013e3182a53d95
Source: PubMed


Medicare Part D, implemented in 2006, provided coverage for prescription drugs to all Medicare beneficiaries.
To examine the effect of Part D on the financial burden of persons with diagnosed diabetes.
We conducted an interrupted time-series analysis using data from the 1996 to 2008 Medical Expenditure Panel Survey (11,178 persons with diabetes who were covered by Medicare, and 8953 persons aged 45-64 y with diabetes who were not eligible for Medicare coverage). We then compared changes in 4 outcomes: (1) annual individual out-of-pocket expenditure (OOPE) for prescription drugs; (2) annual individual total OOPE for all health care services; (3) annual total family OOPE for all health care services; and (4) percentage of persons with high family financial burden (OOPE ≥10% of income).
For Medicare beneficiaries with diabetes, Part D was associated with a 28% ($530) decrease in individual annual OOPE for prescription drugs, a 23% ($560) reduction in individual OOPE for all health care, a 23% ($863) reduction in family OOPE for all health care, and a 24% reduction in the percentage of families with high financial burden in 2006. There were similar reductions in 2007 and 2008. By 2008, the percentage of Medicare beneficiaries with diabetes living in high financial burden families was 37% lower than it would have been had Part D not been in place.
Introduction of Part D coverage was associated with a substantial reduction in the financial burden of Medicare beneficiaries with diabetes and their families.

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    ABSTRACT: OBJECTIVE High out-of-pocket (OOP) costs can be an obstacle to health-care access and treatment compliance. This study investigated trends in high OOP health-care burden in people with diabetes.RESEARCH DESIGN AND METHODS Using Medical Expenditure Panel Survey 2001-2011 data, we examined trends in the proportion of people aged 18-64 years with diabetes facing a high OOP burden. We also examined whether the trend differed by insurance status (private insurance, public insurance, or no insurance) or by income level (poor and near poor, low income, middle income, or high income).RESULTSIn 2011, 23% of people with diabetes faced high OOP burden. Between 2001-2002 and 2011, the proportion of people facing high OOP burden fell by 5 percentage points (P < 0.01). The proportion of those who were publicly insured decreased by 22 percentage points (P < 0.001) and of those who were uninsured by 12 percentage points (P = 0.01). Among people with diabetes who were poor and near poor and those with low income, the proportion facing high OOP burden decreased by 21 (P < 0.001) and 13 (P = 0.01) percentage points, respectively; no significant change occurred in the proportion with private insurance or middle and high incomes between 2001-2002 and 2011.CONCLUSIONS The past decade has seen a narrowing of insurance coverage and income-related disparities in high OOP burden in people with diabetes, yet almost one-fourth of all people with diabetes still face a high OOP burden.
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