Holcombe R F, Griffin J
Department of Medicine, Louisiana State University Medical Center, Shreveport 71130-3932.
South Med J. 1993 Feb;86(2):151-6. doi: 10.1097/00007611-199302000-00001.
To determine whether insurance status (payer class) affects the amount and type of pain medication prescribed, and whether patients in those groups without prescription drug coverage received lower-cost medications, a case-control study with retrospective chart review was initiated in a university-based hematology/oncology practice in northwest Louisiana. Charts of 710 active patients among all insurance groups (private insurance, Medicare, Medicaid, State Hospital System) were analyzed to determine insurance status, pain medication (amount and type), and diagnosis. The proportion of Medicaid patients receiving pain medications was significantly increased in relation to their representation in the practice when compared with Medicare patients, patients with private insurance, uninsured patients whose health care costs were provided by the State Hospital System, and the overall patient population. Medicaid patients, especially those with solid tumor malignancies, received the most expensive class of pain medications at a significantly higher rate than other patients. In the studied population of hematology and oncology patients, there is a significant difference in the amount and type of pain medications prescribed between patients with prescription drug coverage (Medicaid) and those without (all other groups including those covered by the statewide system). We propose that consideration be given to alternative methods of financing prescription medications for medically indigent patients.
为了确定保险状况（支付方类别）是否会影响所开止痛药物的数量和类型，以及那些没有处方药保险的患者群体是否会使用成本较低的药物，在路易斯安那州西北部一家大学附属医院的血液学/肿瘤学科室开展了一项回顾性病历审查的病例对照研究。分析了所有保险群体（私人保险、医疗保险、医疗补助、州立医院系统）中710名现患患者的病历，以确定保险状况、止痛药物（数量和类型）以及诊断情况。与医疗保险患者、有私人保险的患者、由州立医院系统支付医疗费用的未参保患者以及全体患者群体相比，医疗补助患者在该科室中的占比与接受止痛药物治疗的比例显著增加。医疗补助患者，尤其是患有实体瘤恶性肿瘤的患者，接受最昂贵一类止痛药物治疗的比例显著高于其他患者。在该血液学和肿瘤学患者研究群体中，有处方药保险（医疗补助）的患者和没有保险的患者（包括全州系统覆盖的患者在内的所有其他群体）所开止痛药物的数量和类型存在显著差异。我们建议考虑为医疗贫困患者提供处方药的其他筹资方式。
