有和没有低收入补贴的医疗保险D部分受益人的处方药支出模式和药物依从性
Patterns of prescription drug expenditures and medication adherence among medicare part D beneficiaries with and without the low-income supplement.
作者信息
Yala Stella M, Duru Obidiugwu Kenrik, Ettner Susan L, Turk Norman, Mangione Carol M, Brown Arleen F
机构信息
David Geffen School of Medicine at University of California, Los Angeles and Department of Medicine, Division of Cardiology, University of California, Los Angeles 10833 Le Conte Avenue A2-237 Center for the Health Sciences, Los Angeles, CA, 90024, USA.
David Geffen School of Medicine at University of California, Los Angeles, Department of Medicine, Division of General Internal Medicine & Health Services Research, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA, 90024, USA.
出版信息
BMC Health Serv Res. 2014 Dec 20;14:665. doi: 10.1186/s12913-014-0665-3.
BACKGROUND
The association between the Medicare Part D low-income subsidy (LIS), gap coverage, and outcomes such as medical expenditures, prescription fills, and medication adherence is not well understood. The purpose of this study was to examine the relationship between the LIS and these measures for patients within a large, national Part D plan in the United States.
METHODS
In this cross-sectional, retrospective analysis, we compared total and plan expenditures, out-of-pocket costs, and medication fills and adherence for three categories of Medicare beneficiaries: non-LIS beneficiaries without gap coverage (non-LIS/non-GC), non-LIS beneficiaries with gap coverage (non-LIS/GC), and LIS beneficiaries (LIS).
RESULTS
LIS beneficiaries, relative to non-LIS/non-GC and non-LIS/GC beneficiaries, had higher total expenditures ($1,887 vs. $1,360 vs. $1,341); lower out-of-pocket costs ($148 vs. $546 vs. $570); more expenditures exceeding the gap threshold (27.6% vs. 18.4% vs. 16.9%); and slightly higher adherence to blood pressure (65.6% vs. 64.2% vs. 62.4%); diabetes (62.5% vs. 57.7 vs. 57.4%); and lipid-lowering (59.6% vs. 57.0 vs. 55.6%) medications.
CONCLUSION
LIS beneficiaries had higher total expenditures, lower out-of-pocket costs, and modestly better adherence to diabetes medications than non-LIS/non-GC and non-LIS/GC beneficiaries.
背景
医疗保险D部分低收入补贴（LIS）、缺口保险与医疗支出、处方配药及药物依从性等结果之间的关联尚未得到充分理解。本研究的目的是在美国一个大型全国性D部分计划中，考察LIS与这些指标之间的关系。
方法
在这项横断面回顾性分析中，我们比较了三类医疗保险受益人的总支出和计划支出、自付费用、处方配药及依从性：无缺口保险的非LIS受益人（非LIS/非GC）、有缺口保险的非LIS受益人（非LIS/GC）以及LIS受益人（LIS）。
结果
与非LIS/非GC和非LIS/GC受益人相比，LIS受益人有更高的总支出（分别为1887美元、1360美元和1341美元）；更低的自付费用（分别为148美元、546美元和570美元）；更多超过缺口阈值的支出（分别为27.6%、18.4%和16.9%）；以及对血压药物（分别为65.6%、64.2%和62.4%）、糖尿病药物（分别为62.5%、57.7%和57.4%）和降脂药物（分别为59.6%、57.0%和55.6%）略高的依从性。
结论
与非LIS/非GC和非LIS/GC受益人相比，LIS受益人有更高的总支出、更低的自付费用，并且对糖尿病药物的依从性略好。
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