Global Health Economics, Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA.
Health Serv Res. 2011 Aug;46(4):1104-23. doi: 10.1111/j.1475-6773.2011.01273.x. Epub 2011 May 24.
To quantify the impact of Medicare Part D eligibility on medication utilization, emergency department use, hospitalization, and preference-based health utility among civilian noninstitutionalized Medicare beneficiaries.
Difference-in-differences analyses were used to estimate the effects of Part D eligibility on health outcomes by comparing a 12-month period before and after Part D implementation using the Medical Expenditure Panel Survey. Models adjusted for sociodemographic characteristics and health status and compared Medicare beneficiaries aged 65 and older with near elderly aged 55-63 years old.
Five hundred and fifty-six elderly and 549 near elderly were included. After adjustment, Part D was associated with a U.S.$179.86 (p=.034) reduction in out-of-pocket costs and an increase of 2.05 prescriptions (p=.081) per patient year. The associations between Part D and emergency department use, hospitalizations, and preference-based health utility did not suggest cost offsets and were not statistically significant.
Although there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries during the first year after Part D, there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D during its first year of implementation.
量化医疗保险部分 D 资格对平民非住院医疗保险受益人的药物使用、急诊使用、住院和基于偏好的健康效用的影响。
使用差异中的差异分析，通过比较医疗保险部分 D 实施前后 12 个月的医疗支出面板调查，来估计部分 D 资格对健康结果的影响。模型调整了社会人口统计学特征和健康状况，并比较了 65 岁及以上的医疗保险受益人与接近 63 岁的老年人。
共纳入 556 名老年人和 549 名接近老年人。调整后，部分 D 与自付费用减少 179.86 美元（p=.034）和每位患者每年增加 2.05 份处方（p=.081）有关。部分 D 与急诊使用、住院和基于偏好的健康效用之间的关联并未表明成本抵消，且无统计学意义。
尽管在医疗保险部分 D 实施后的第一年，医疗保险受益人的自付费用大幅减少，药物使用量适度增加，但在部分 D 资格的第一年，没有证据表明急诊使用、住院或基于偏好的健康效用有所改善。
