Woodward R S, Page T F, Soares R, Schnitzler M A, Lentine K L, Brennan D C
Department of Health Management, University of New, Hampshire, Durham, NH, USA.
Am J Transplant. 2008 Dec;8(12):2636-46. doi: 10.1111/j.1600-6143.2008.02422.x.
Beginning January 1, 2000, Medicare extended coverage of immunosuppression medications from 3 years to lifetime based on age >65 years or disability. Using United States Renal Data System (USRDS) data for Medicare-insured recipients of kidney transplants between July 1995 and December 2000, we identified four cohorts of Medicare-insured kidney transplant recipients. Patients in cohort 1 were individuals who were both eligible and received lifetime coverage. Patients in cohort 2 would have been eligible, but their 3-year coverage expired before lifetime coverage was available. Patients in cohort 3 were ineligible for lifetime coverage because of youth or lack of disability. Patients in cohort 4 were transplanted between 1995 and 1996 and were ineligible for lifetime coverage. Incomes were categorized by ZIP code median household income from census data. Lifetime extension of Medicare immunosuppression was associated with improved allograft survival among low-income transplant recipients in the sense that the previously existing income-related disparities in graft survival in cohort 2 were not apparent in cohort 1. Ineligible individuals served as a control group; the income-related disparities in graft survival observed in the early cohort 4 persisted in more recent cohort 3. Multivariate proportional hazards models confirmed these findings. Future work should evaluate the cost effectiveness of these coverage increases, as well as that of benefits extensions to broader patient groups.
从2000年1月1日起，医疗保险将免疫抑制药物的覆盖期限从3年延长至终身，条件是年龄大于65岁或有残疾。利用美国肾脏数据系统（USRDS）中1995年7月至2000年12月期间参加医疗保险的肾移植受者的数据，我们确定了四组参加医疗保险的肾移植受者。第1组患者是既符合条件又获得终身保险的个体。第2组患者本应符合条件，但他们的3年保险在终身保险可用之前就已到期。第3组患者因年轻或无残疾而无资格获得终身保险。第4组患者在1995年至1996年期间接受移植，无资格获得终身保险。收入根据人口普查数据中的邮政编码中位数家庭收入进行分类。医疗保险免疫抑制期限的延长与低收入移植受者的移植肾存活率提高相关，因为第2组中先前存在的与收入相关的移植肾存活率差异在第1组中并不明显。不符合条件的个体作为对照组；在早期的第4组中观察到的与收入相关的移植肾存活率差异在最近的第3组中仍然存在。多变量比例风险模型证实了这些发现。未来的工作应评估这些保险覆盖范围增加的成本效益，以及将福利扩展到更广泛患者群体的成本效益。
