Disparities in Access to Essential New Prescription Drugs between Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanic Whites
The University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee, United StatesMedical Care Research and Review (Impact Factor: 2.62). 01/2007; 63(6):742-63. DOI: 10.1177/1077558706293638
Prior studies do not address racial and ethnic disparities in essential new drug use and whether disparities decrease through time. Using the Medical Expenditure Panel Survey (1996-2001), racial and ethnic disparities were examined separately by comparing non-Hispanic whites to non-Hispanic blacks and Hispanic whites, respectively. New drugs were defined as approved within the past 5 years, and an expert panel identified essential drugs. Negative binomial models adjusted for socioeconomic and health characteristics. The mean annual number of times essential new drugs were obtained among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites were 1.02, 0.94, and 0.70, respectively. After adjusting for confounders, ethnic disparities generally were not significant, but racial disparities became significant. This study did not identify declining disparities during early years of drugs' life cycles. Disparities exist in new, essential drug acquisition between non-Hispanic whites and non-Hispanic blacks. Socioeconomic and health characteristics explain many of the observed disparities.
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ABSTRACT: Previous studies have examined racial and ethnic disparities in the use of selective serotonin reuptake inhibitors (SSRI). This study aims to examine the economic implications of these disparities. In this retrospective observational study, the study sample was adult survey respondents with a diagnosis of depression from the Medical Expenditure Panel Survey (2002-2003). SSRI use was measured as the number of times when SSRIs were obtained. The racial and ethnic disparities in SSRI use were examined employing a negative binomial model. The economic implications of disparities were explored using a linear regression with SSRI use as an independent variable. Interaction terms between the variable for SSRI use and dummy variables for racial and ethnic groups were included to explore whether the relationships between SSRI use and health expenditures differ across racial and ethnic groups. The mean number of times of SSRI use was higher for non-Hispanic whites than non-Hispanic blacks (3.02 vs. 1.79; p < 0.05) and Hispanic whites (3.02 vs. 1.68; p < 0.05). These differences were still significant after adjusting for covariates (p < 0.05). In the multivariate analysis, each time of SSRI use was associated with health expenditures of $301 higher. Neither dummy variables for racial and ethnic groups nor the interaction terms between these dummy variables and the variable for SSRI use were significant. The lower use of SSRIs among minorities compared to non-Hispanic whites is associated with lower health expenditures among minorities. SSRI may be a proxy for improved access to health care due to under-treatment of depression in general. The main limitation of this study is that its observational nature does not allow the researchers to determine whether the association between SSRI use and the increase in health expenditures is a causal effect.
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ABSTRACT: Prescription drugs are instrumental to managing and preventing chronic disease. Recent changes in US prescription drug cost sharing could affect access to them. To synthesize published evidence on the associations among cost-sharing features of prescription drug benefits and use of prescription drugs, use of nonpharmaceutical services, and health outcomes. We searched PubMed for studies published in English between 1985 and 2006. Among 923 articles found in the search, we identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n = 65), pharmacy benefit caps or monthly prescription limits (n = 11), formulary restrictions (n = 41), and reference pricing (n = 16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes. Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention. Pharmacy benefit design represents an important public health tool for improving patient treatment and adherence. While increased cost sharing is highly correlated with reductions in pharmacy use, the long-term consequences of benefit changes on health are still uncertain.
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ABSTRACT: Previous studies reported that some minority childhood cancer patients are likely to develop worse outcomes than white children. This study examines whether there are racial and ethnic disparities in health expenditures among children with cancer. Research design and methods: A retrospective study was conducted among children (younger than 20) with cancer diagnoses in the Medical Expenditure Panel Survey (MEPS; 1996 to 2004). Total health expenditures and the following subcategories were examined across racial and ethnic groups: (1) office-based visits; (2) outpatient visits; (3) inpatient and emergency room visits; (4) home health care; (5) prescription drugs; and (6) dental, vision, and other health care expenditures. Consumer price indexes were used to convert all expenditures to 2004 dollars. A classical linear model was analyzed using the natural logarithm of health expenditures as the dependent variable, with the purpose of determining whether there were racial and ethnic differences in health expenditures after adjusting for confounding factors. Study sample included 394 non-Hispanic whites (weighted to 4 958 685), 53 non-Hispanic blacks (weighted to 352 534), and 94 Hispanic whites (weighted to 424 319). Hispanic blacks and other minority populations were excluded from the analysis due to insufficient sample size. The annual total health expenditure for treating each child with cancer was $3467.40, $2156.15, and $5545.34, respectively, among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites. The differences in the various subcategories of health expenditures across racial and ethnic groups were generally not significant according to both descriptive and analytical analyses with very few exceptions. This study did not identify significant racial and ethnic disparities in health care costs. However, one important study limitation is the small sample size of the minority populations in the study sample.