The Effect of Medicare Part D on Drug and Medical Spending.

被引:108
作者
Zhang, Yuting [1 ]
Donohue, Julie M. [1 ]
Lave, Judith R. [1 ]
O'Donnell, Gerald [2 ]
Newhouse, Joseph P. [3 ,4 ,5 ]
机构
[1] Univ Pittsburgh, Dept Hlth Policy & Management, Grad Sch Publ Hlth, Pittsburgh, PA 15261 USA
[2] Highmark, Pittsburgh, PA USA
[3] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
[4] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA
[5] Harvard Univ, Harvard Kennedy Sch, Cambridge, MA 02138 USA
关键词
BENEFICIARIES; ADJUSTMENT; COVERAGE; EVENTS; COSTS;
D O I
10.1056/NEJMsa0807998
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: It is not known what effect the increased use of prescription drugs by enrollees in Medicare Part D has had on spending for other medical care. Methods: We compared spending for prescription drugs and other medical care 2 years before the implementation of Part D in January 2006 with such expenditures 2 years after the program's implementation in four groups of elderly beneficiaries: Medicare Advantage enrollees with stable, uncapped, employer-based drug coverage throughout the study period (no-cap group), those who had no previous drug coverage, and those who had previous limited benefits (with either a $150 or a $350 quarterly cap) before they were covered by Part D in 2006. Results: Between December 2005 and December 2007, as compared with the increase in the no-cap group, the increase in total monthly drug spending was $41 higher (95% confidence interval [CI], $33 to $50) (74%) among enrollees with no previous drug coverage, $27 higher (95% CI, $20 to $34) (27%) among those with a previous $150 quarterly cap, and $13 higher (95% CI, $8 to $18) (11%) among those with a previous $350 cap. The use of both lipid-lowering and antidiabetic medications rose in the groups with no or minimal previous drug coverage. As compared with expenditures in the no-cap group, monthly medical expenditures (excluding drugs) were $33 lower (95% CI, $29 to $37) in the group with no previous coverage and $46 lower (95% CI, $29 to $63) in the group with a previous $150 quarterly cap, whereas medical spending was $30 higher (95% CI, $25 to $36) in the group with a previous $350 cap. Conclusions: Enrollment in Medicare Part D was associated with increased spending on prescription drugs. Groups that had no or minimal drug coverage before the implementation of Part D had reductions in other medical spending that approximately offset the increased spending on drugs, but medical spending increased in the group that had more generous previous coverage. N Engl J Med 2009;361:52-61.
引用
收藏
页码:52 / 61
页数:10
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