Millett Christopher, Everett Charles J, Matheson Eric M, Bindman Andrew B, Mainous Arch G
Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA.
Arch Intern Med. 2010 Aug 9;170(15):1325-30. doi: 10.1001/archinternmed.2010.208.
Medicare Part D, introduced in January 2006, was intended to decrease beneficiaries' out-of-pocket expenditures on medications.
We examined whether this policy was successful in achieving this goal, including effects on Medicare beneficiaries without previous drug coverage and those who previously received coverage through Medicaid, in a longitudinal study of out-of-pocket expenditures on medications in 1504 Medicare beneficiaries 65 years and older participating in the 2005 and 2006 waves of the Medical Expenditure Panel Survey.
Mean annual out-of-pocket expenditures on medications decreased by 32% ($320; 95% confidence interval [CI], $250-$391), from $1011 to $691, in the year after Part D was implemented for all Medicare beneficiaries in the Medical Expenditure Panel Survey. Mean annual out-of-pocket expenditures on medications decreased by 49% ($748; 95% CI, $600-$897), from $1533 to $784, in beneficiaries without previous drug coverage who enrolled in a Part D plan. Beneficiaries who did not enroll experienced a mean reduction of 32% ($353; 95% CI, $188-$518), from $1116 to $763. Mean annual out-of-pocket expenditures on medications remained similar in dual Medicare and Medicaid beneficiaries.
The introduction of Medicare Part D was associated with reductions in Medicare beneficiaries' out-of-pocket expenditures on medications, particularly in beneficiaries without previous drug coverage, and did not substantially change expenditures for Medicare beneficiaries who previously received pharmacy coverage through Medicaid. However, a question remains about whether the high public cost of providing pharmacy coverage through Medicare is worth the substantially lower financial benefit derived by beneficiaries.
2006年1月推出的医疗保险D部分旨在减少受益人的药品自付费用。
在一项纵向研究中，我们调查了这一政策是否成功实现了这一目标，包括对以前没有药物保险的医疗保险受益人和那些以前通过医疗补助获得保险的受益人的影响。该研究涉及1504名65岁及以上参加2005年和2006年医疗支出小组调查的医疗保险受益人在药品方面的自付费用。
在医疗支出小组调查中，对所有医疗保险受益人而言，在D部分实施后的一年里，药品的年均自付费用从1011美元降至691美元，降幅为32%（320美元；95%置信区间[CI]，250 - 391美元）。在参加D部分计划且以前没有药物保险的受益人中，药品的年均自付费用从1533美元降至784美元，降幅为49%（748美元；95% CI，600 - 897美元）。未参保的受益人平均减少了32%（353美元；95% CI，188 - 518美元）,从1116美元降至763美元。医疗保险和医疗补助双重受益人的药品年均自付费用保持相似。
医疗保险D部分的推出与医疗保险受益人在药品方面的自付费用减少有关，特别是在以前没有药物保险的受益人中，并且没有大幅改变以前通过医疗补助获得药品保险的医疗保险受益人的支出。然而，通过医疗保险提供药品保险的高昂公共成本是否值得受益人获得的大幅降低的经济利益，这一问题仍然存在。
