Mobley Lee R, Amaral Pedro, Kuo Tzy-Mey, Zhou Mei, Bose Srimoyee
Georgia State University, 1 Park Place, Suite 700, Atlanta, GA, 30304, USA.
Cedeplar - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Health Econ Rev. 2017 Dec;7(1):13. doi: 10.1186/s13561-017-0147-5. Epub 2017 Mar 9.
To examine how FFS Medicare utilization of endoscopy procedures for colorectal cancer (CRC) screening changed after implementation of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2006, which provided subsidized drug coverage and expanded the geographic availability of Medicare managed care plans across the US.
DATA SOURCES/STUDY SETTING: Using secondary data from 100% FFS Medicare enrollees, we analyzed endoscopy utilization during two intervals, 2001-2005 and 2006-2009.
We examined change in predictors of county-level endoscopy utilization rates based on a conceptual model of market supply and demand with spillovers from managed care practices. The equations for each period were estimated jointly in a spatial lag regression model that properly accounts for both place and time effects, allowing robust assessment of changes over time.
DATA COLLECTION/EXTRACTION METHODS: All Medicare FFS enrollees with both Parts A and B coverage who were age 65+, remained alive and living in the same state over the interval were included in the analyses. The later interval used a new cohort defined the same as the earlier interval. 100% Medicare denominator files were also used, providing county of address to use for county-level aggregation. The outcome variable was defined as county-level proportion of enrollees who ever used endoscopy over the interval.
Endoscopy utilization by FFS Medicare increased, and became more accessible across the US. Medicare managed care plan spillovers onto FFS Medicare endoscopy utilization changed over time from a significant negative (restraining) effect in the early period to no significant effect by the later period.
The MMA eased budget constraints for seniors, making endoscopic CRC screening more affordable. The MMA policies also strengthened managed care business prospects, and enrollments in Medicare managed care escalated. The change in managed care spillover effects reflects the gradual acceptance of endoscopic CRC screening procedures, as they emerged as the gold standard during the period.
研究2006年《医疗保险处方药、改进与现代化法案》（MMA）实施后，联邦政府医疗保险（FFS Medicare）用于结直肠癌（CRC）筛查的内窥镜检查程序的使用情况如何变化。该法案提供了补贴药物覆盖范围，并扩大了医疗保险管理式医疗计划在美国各地的地理可及性。
数据来源/研究背景：利用100%联邦政府医疗保险参保人的二手数据，我们分析了2001 - 2005年和2006 - 2009年两个时间段内的内窥镜检查使用情况。
我们基于市场供需概念模型以及管理式医疗实践的溢出效应，研究县级内窥镜检查使用率预测因素的变化。每个时期的方程在空间滞后回归模型中联合估计，该模型能恰当考虑地点和时间效应，从而对随时间的变化进行稳健评估。
数据收集/提取方法：分析纳入了所有年龄在65岁及以上、同时拥有A部分和B部分保险、在此期间存活且居住在同一州的联邦政府医疗保险参保人。后一个时间段使用了与前一个时间段定义相同的新队列。还使用了100%的医疗保险分母文件，提供住址所在县以便进行县级汇总。结果变量定义为在此期间使用过内窥镜检查的参保人的县级比例。
联邦政府医疗保险的内窥镜检查使用率有所提高，且在美国各地更容易获得。医疗保险管理式医疗计划对联邦政府医疗保险内窥镜检查使用的溢出效应随时间发生了变化，从早期显著的负面（抑制）效应到后期无显著效应。
《医疗保险处方药、改进与现代化法案》缓解了老年人的预算限制，使内窥镜结直肠癌筛查更具可承受性。该法案的政策还增强了管理式医疗的商业前景，医疗保险管理式医疗的参保人数也有所增加。管理式医疗溢出效应的变化反映了内窥镜结直肠癌筛查程序逐渐被接受，因为在此期间它成为了金标准。
