Zhang James X, Meltzer David O
Section of Hospital Medicine, Department of Medicine (J.X.Z., D.O.M.); Department of Economics (D.O.M.); and the Harris School of Public Policy (D.O.M.); The University of Chicago.
J Health Med Econ. 2016;2(2). Epub 2016 Feb 25.
Access barriers to effective medication treatment have been a persistent issue for millions of older Americans despite the establishment of Medicare Part D.
We aimed to assess the prevalence rate of cost-related medication non-adherence (CRN) and the patterns of CRN behaviors in Medicare-Medicaid dual eligibles with diabetes.
We used data from the 2011 Medicare Current Beneficiary Survey, a nationally representative sample of Medicare beneficiaries. Multivariate logistic regression analysis was performed to assess CRN rate, controlling for demographics and types of Medicare Part D plans.
The CRN rate in dual-eligible diabetes patients was 21%, compared to 16% in non-dual-eligible diabetes patients (p<0.01). In 2011, the standardized prevalence rate of CRN in dual-eligible diabetes patients was 21%, of those with CRN 29% reported three or more types of CRN behaviors.
Contrary to the common belief that dual eligibles have better insurance coverage for medication due to the assistance from Medicaid to pay some of the out-of-pocket payments, the CRN rate among dual eligibles is high and patients often report multiple types of CRN behaviors. This demonstrates that cost is a significant access barrier for dual-eligible diabetes patients. More research is needed to improve the insurance benefit design and expand insurance coverage for this high-need, high-cost subpopulation.
尽管已设立了医疗保险D部分，但对数百万美国老年人来说，获得有效药物治疗的障碍一直存在。
我们旨在评估与费用相关的药物治疗不依从（CRN）的患病率以及糖尿病医保-医疗补助双重资格受益人的CRN行为模式。
设计、背景、患者、干预措施及主要结局指标：我们使用了2011年医疗保险当前受益人调查的数据，该调查是医疗保险受益人的全国代表性样本。进行多因素逻辑回归分析以评估CRN率，并对人口统计学和医疗保险D部分计划类型进行控制。
双重资格糖尿病患者的CRN率为21%，而非双重资格糖尿病患者为16%（p<0.01）。2011年，双重资格糖尿病患者的CRN标准化患病率为21%，在有CRN的患者中，29%报告了三种或更多类型的CRN行为。
与普遍看法相反，即双重资格者由于医疗补助的帮助支付部分自付费用而在药物保险覆盖方面更好，双重资格者中的CRN率很高，且患者经常报告多种类型的CRN行为。这表明费用是双重资格糖尿病患者的一个重大获取障碍。需要更多研究来改善保险福利设计，并扩大对这个高需求、高成本亚人群的保险覆盖范围。
