Park Young Joo, Martin Erika G
Rockefeller College of Public Affairs & Policy, University at Albany-State University of New York, Albany, NY.
Nelson A. Rockefeller Institute of Government, State University of New York, Albany, NY.
Health Serv Res. 2017 Oct;52(5):1685-1728. doi: 10.1111/1475-6773.12534. Epub 2016 Aug 1.
To update a past systematic review on whether Medicare Part D changed drug utilization and out-of-pocket (OOP) costs overall and within subpopulations, and to identify evidence gaps.
DATA SOURCES/STUDY SETTING: Published and gray literature from 2010 to 2015 meeting prespecified screening criteria, including having a comparison group, and utilization or OOP cost outcomes.
We conducted a systematic literature review with a quality assessment.
DATA COLLECTION/EXTRACTION METHODS: For each study, we extracted information on study design, data sources, analytic methods, outcomes, and limitations. Because outcome measures vary across studies, we did a qualitative synthesis rather than meta-analysis.
Sixty-five studies met screening criteria. Overall, Medicare Part D enrollees have increased drug utilization and decreased OOP costs, but coverage gaps limit the program's impact. Beneficiaries whose insurance becomes more generous after enrollment had disproportionately increased drug utilization and decreased OOP costs. Outcomes among dual-eligibles were mixed.
There is strong evidence on how Medicare Part D and the donut hole coverage gap affect utilization and OOP costs, but weak evidence on how effects vary among dual-eligibles or across diseases. Findings suggest that the Affordable Care Act's provisions to expand coverage and reduce the donut hole should improve patient outcomes.
更新一项关于医疗保险D部分是否改变了总体及亚人群药物使用情况和自付费用（OOP）的既往系统评价，并识别证据空白。
数据来源/研究背景：2010年至2015年期间发表的及灰色文献，符合预先设定的筛选标准，包括设有对照组以及使用情况或自付费用结果。
我们进行了一项带有质量评估的系统文献综述。
数据收集/提取方法：对于每项研究，我们提取了关于研究设计、数据来源、分析方法、结果及局限性的信息。由于不同研究的结果测量指标各异，我们进行了定性综合分析而非荟萃分析。
65项研究符合筛选标准。总体而言，医疗保险D部分的参保者药物使用增加，自付费用降低，但保险覆盖缺口限制了该计划的影响。参保后保险福利变得更优厚的受益人群药物使用增加和自付费用降低的比例过高。双重资格受益人的结果参差不齐。
有充分证据表明医疗保险D部分及环形缺口保险覆盖如何影响使用情况和自付费用，但关于双重资格受益人或不同疾病间影响差异的证据不足。研究结果表明，《平价医疗法案》中扩大保险覆盖范围和缩小环形缺口的条款应能改善患者结局。
