Division of Health Policy and Management, University of Minnesota School of Public Health, PWB 15-211, 516 Delaware Street SE, Minneapolis, MN 55455. Email:
Am J Manag Care. 2022 Mar;28(3):133-136. doi: 10.37765/ajmc.2022.88840.
To estimate the association of 340B contract pharmacy growth between 2009 and 2019 with county-level characteristics, including availability of health care providers, health care spending, population, and socioeconomic characteristics.
Observational study.
We constructed county-level maps of 340B contract pharmacy penetration for the years 2009 and 2019 by 340B participant type (hospital or safety-net clinic). We then used a multivariable linear probability regression model to estimate the association of county-level characteristics in 2009 with the probability of gaining at least one 340B contract pharmacy within the county by 2019. We estimated separate regressions for safety-net clinics and hospitals.
We find that growth of contracts with 340B hospitals was uncorrelated with uninsured rates, poverty rates, or areas of medical underservice. By contrast, we find that growth of contracts with 340B safety-net clinics was positively correlated with poverty rates and metropolitan statistical status. These findings suggest different patterns of access for patients.
Our results add systematic evidence of a difference in how the 2 main types of 340B participants-hospitals and safety-net clinics-use the 340B program. Policy proposals to reform 340B should consider reforms for safety-net clinics and hospitals separately.
评估 2009 年至 2019 年期间 340B 合同药房增长与县级特征的关系，包括医疗服务提供者的可用性、医疗支出、人口和社会经济特征。
观察性研究。
我们通过 340B 参与方类型（医院或医疗保障诊所）构建了 2009 年和 2019 年 340B 合同药房渗透率的县级地图。然后，我们使用多变量线性概率回归模型来估计 2009 年县级特征与 2019 年该县获得至少一家 340B 合同药房的概率之间的关联。我们分别为医疗保障诊所和医院估计了回归模型。
我们发现，与未参保率、贫困率或医疗服务不足地区相比，340B 医院合同的增长与未参保率、贫困率或医疗服务不足地区无关。相比之下，我们发现，与 340B 医疗保障诊所合同的增长与贫困率和大都市统计地位呈正相关。这些发现表明了患者获得途径的不同模式。
我们的研究结果提供了关于 340B 计划的两种主要参与方类型（医院和医疗保障诊所）如何使用该计划的差异的系统证据。改革 340B 的政策提案应分别考虑对医疗保障诊所和医院进行改革。
