Morgan Robert O, Petersen Laura A, Hasche Jennifer C, Davila Jessica A, Byrne Margaret M, Osemene Nora I, Wei Iris I, Johnson Michael L
Division of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, TX, USA.
Am J Manag Care. 2009 Mar 16;15(3):e1-8.
To determine how Medicare benefits affect veterans' use of Veterans Health Administration (VHA) pharmacy services.
Retrospective analysis of veterans dually enrolled in the Veterans Health Administration and Medicare healthcare systems.
We used VHA and Medicare administrative data for calendar year 2002 to examine the effect of Medicare HMO pharmacy benefit levels on VHA pharmacy use.
In 2002, 64% of the VHA and Medicare dually enrolled veterans in our study sample received medications from the VHA. Use of VHA pharmacy services varied monotonically by the level of pharmacy benefits among Medicare HMO enrollees, with veterans enrolled in plans with both low and high pharmacy benefit levels significantly less likely to use VHA pharmacy services than veterans in plans with no pharmacy benefits (odds ratios = .83 and .53, respectively, versus plans with no benefits). Among VHA pharmacy users, enrollment in plans with high levels of benefits was associated with significantly lower annual pharmacy costs than enrollment in plans with no benefits or enrollment in traditional Medicare.
Our findings indicate that non-VHA pharmacy benefits affect both the likelihood and magnitude of VHA pharmacy use. This suggests that Medicare pharmacy coverage (Part D) may significantly reduce the demand for VHA pharmacy services, particularly in geographic regions previously underserved by Medicare managed care plans.
确定医疗保险福利如何影响退伍军人对退伍军人健康管理局（VHA）药房服务的使用。
对同时加入退伍军人健康管理局和医疗保险医疗系统的退伍军人进行回顾性分析。
我们使用2002年日历年的VHA和医疗保险管理数据，以研究医疗保险健康维护组织（HMO）药房福利水平对VHA药房使用的影响。
2002年，我们研究样本中同时加入VHA和医疗保险的退伍军人中有64%从VHA获得药物。医疗保险HMO参保者中，VHA药房服务的使用随药房福利水平呈单调变化，与无药房福利计划的退伍军人相比，参保药房福利水平低和高的计划的退伍军人使用VHA药房服务的可能性显著降低（优势比分别为0.83和0.53，与无福利计划相比）。在VHA药房使用者中，参保高福利水平计划的年度药房成本显著低于无福利计划或传统医疗保险计划。
我们的研究结果表明，非VHA药房福利会影响VHA药房使用的可能性和规模。这表明医疗保险药房覆盖范围（D部分）可能会显著降低对VHA药房服务的需求，特别是在以前医疗保险管理式医疗计划服务不足的地理区域。
