Curtis Lesley H, Law Amy W, Anstrom Kevin J, Schulman Kevin A
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
Med Care. 2004 May;42(5):439-46. doi: 10.1097/01.mlr.0000124247.03660.09.
Despite continuing debate over a prescription drug benefit for the Medicare program, there has been relatively little research estimating the potential cost of providing such a benefit.
The objective of this study was to estimate the effect of prescription drug insurance on outpatient prescription drug expenditures among the elderly.
We studied respondents aged > or =65 years to the 1997 Medical Expenditure Panel Survey, a representative survey of the U.S. noninstitutionalized population. Survey-weighted linear regression models were used to estimate the probability of any expenditures and total expenditures while controlling for sociodemographic characteristics, chronic conditions, and health status.
We used prescription drug insurance status and outpatient prescription drug expenditures.
An estimated 34 million elderly people filled 630 million prescriptions in 1997. Thirty-seven percent did not have prescription drug insurance. Total prescription drug expenditures exceeded $23 billion. Persons without prescription drug insurance spent slightly less than $7 billion; those with insurance spent more than $16 billion. After controlling for health status, comorbidity, and demographic characteristics, prescription drug insurance increased expenditures by $183 per person. The marginal increase in total expenditures of extending the average observed benefit to those currently uninsured is $2.3 billion (95% confidence interval, $1.2-3.5 billion).
Proposals for a Medicare drug benefit provide high copayments to protect against insurance effects and to address uncertainty in cost estimates of the proposed benefit. By quantifying the insurance effect on expenditures among the elderly, the data reported here could reduce uncertainty in the budget estimation process.
尽管对于医疗保险计划中的处方药福利一直存在争议，但估算提供此类福利的潜在成本的研究相对较少。
本研究的目的是估算处方药保险对老年人门诊处方药支出的影响。
我们研究了1997年医疗支出小组调查中年龄≥65岁的受访者，该调查是对美国非机构化人口的代表性调查。使用调查加权线性回归模型来估算在控制社会人口统计学特征、慢性病和健康状况的情况下发生任何支出和总支出的概率。
我们使用了处方药保险状况和门诊处方药支出。
据估计，1997年有3400万老年人开具了6.3亿张处方。37%的人没有处方药保险。处方药总支出超过230亿美元。没有处方药保险的人支出略低于70亿美元；有保险的人支出超过160亿美元。在控制健康状况、合并症和人口统计学特征后，处方药保险使每人支出增加了183美元。将平均观察到的福利扩展到目前未参保者的总支出边际增加额为23亿美元（95%置信区间，12亿 - 35亿美元）。
医疗保险药品福利提案提供高额自付费用，以防范保险效应并解决拟议福利成本估算中的不确定性。通过量化保险对老年人支出的影响，此处报告的数据可以减少预算估算过程中的不确定性。
