PDP 还是 MA-PD？CMS 第 25 区的医疗保险部分 D 注册决策。

PDP or MA-PD? Medicare part D enrollment decisions in CMS Region 25.

机构信息

Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, 308 Harvard St. SE, Minneapolis, MN 55455, USA.

出版信息

Res Social Adm Pharm. 2010 Jun;6(2):130-42. doi: 10.1016/j.sapharm.2010.04.002.

DOI:10.1016/j.sapharm.2010.04.002

PMID:20511112

Abstract

BACKGROUND

The Medicare Prescription Drug Improvement and Modernization Act of 2003 provides outpatient prescription drug coverage for Medicare beneficiaries through private insurers. This coverage is available through 2 primary venues: stand-alone prescription drug plans (PDPs) and integrated managed care (or Medicare Advantage) plans that also provide prescription drug coverage (MA-PDs).

OBJECTIVES

The first objective was to describe factors associated with Medicare beneficiaries choosing to enroll in any Medicare part D PDP. The second objective was to describe factors associated with the choice of an MA-PD, given enrollment in the part D program.

METHODS

The study used a cross-sectional, survey design. Data were collected from a stratified random sample of 5000 community-dwelling adults, aged 65 years and older in the Center for Medicaid and Medicare Services Region 25. Data were collected by means of a mailed questionnaire. Data analyses included univariate and bivariate descriptive statistics and multivariate probit modeling.

RESULTS

The overall adjusted response rate was 50.2% (2309 of 4603). Data from 1490 respondents (32.4% of those attempted) were analyzed in this study. Nearly 75% of sample members elected to enroll in one of the Medicare part D coverage options in 2007, with more than 3 times as many choosing a PDP compared with a MA-PD option (57.2% vs 17.8%). A variety of variables including rurality, plan price, perceived future need for medications, and preferences emerged as important predictors of choosing to enroll in any Medicare part D drug plan, whereas rurality, state of residence, and number of diagnosed medical conditions were associated with the decision to enroll in a MA-PD.

CONCLUSIONS

Models of health insurance demand and plan choice applied in this context appear to be modestly effective. Rurality and state of residence were particularly important contributors to both of these decisions, as were a variety of individual characteristics.

摘要

背景

2003 年的《医疗保险处方药改进和现代化法案》通过私人保险公司为医疗保险受益人提供门诊处方药保险。这种保险可以通过两种主要方式获得：独立处方药计划（PDP）和综合管理式医疗（或医疗保险优势）计划，这些计划也提供处方药保险（MA-PD）。

目的

第一个目标是描述与医疗保险受益人选择参加任何医疗保险 D 部分 PDP 相关的因素。第二个目标是描述在参加 D 部分计划的情况下，选择 MA-PD 的相关因素。

方法

该研究使用了横断面、调查设计。数据来自医疗保险和医疗补助服务中心第 25 区的一个分层随机抽样，样本包括 5000 名年龄在 65 岁及以上、居住在社区的成年人。数据通过邮寄问卷收集。数据分析包括单变量和双变量描述性统计以及多变量概率模型。

结果

总体调整后的回复率为 50.2%（4603 人中的 2309 人）。本研究分析了来自 1490 名受访者（尝试受访者的 32.4%）的数据。在 2007 年，样本成员中有近 75%选择参加其中一种医疗保险 D 部分保险，选择 PDP 的人数是 MA-PD 选项的 3 倍多（57.2%比 17.8%）。各种变量，包括农村地区、计划价格、对未来用药的需求以及偏好，成为选择参加任何医疗保险 D 部分药物计划的重要预测因素，而农村地区、居住地和诊断出的疾病数量与参加 MA-PD 的决定有关。