@article {7640, title = {Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage.}, journal = {JAMA}, volume = {306}, year = {2011}, note = {McWilliams, J Michael Zaslavsky, Alan M Huskamp, Haiden A Comparative Study Research Support, Non-U.S. Gov{\textquoteright}t United States JAMA : the journal of the American Medical Association JAMA. 2011 Jul 27;306(4):402-9.}, month = {2011 Jul 27}, pages = {402-9}, publisher = {306}, abstract = {

CONTEXT: Implementation of Medicare Part D was followed by increased use of prescription medications, reduced out-of-pocket costs, and improved medication adherence. Its effects on nondrug medical spending remain unclear.

OBJECTIVE: To assess differential changes in nondrug medical spending following the implementation of Part D for traditional Medicare beneficiaries with limited prior drug coverage.

DESIGN, SETTING, AND PARTICIPANTS: Nationally representative longitudinal survey data and linked Medicare claims from 2004-2007 were used to compare nondrug medical spending before and after the implementation of Part D by self-reported generosity of prescription drug coverage before 2006. Participants included 6001 elderly Medicare beneficiaries from the Health and Retirement Study, including 2538 with generous and 3463 with limited drug coverage before 2006. Comparisons were adjusted for sociodemographic and health characteristics and checked for residual confounding by conducting similar comparisons for a control cohort from 2002-2005.

MAIN OUTCOME MEASURE: Nondrug medical spending assessed from claims, in total and by type of service (inpatient and skilled nursing facility vs physician services).

RESULTS: Total nondrug medical spending was differentially reduced after January 1, 2006, for beneficiaries with limited prior drug coverage (-$306/quarter [95\% confidence interval {CI}, -$586 to -$51]; P = .02), relative to beneficiaries with generous prior drug coverage. This differential reduction was explained mostly by differential changes in spending on inpatient and skilled nursing facility care (-$204/quarter [95\% CI, -$447 to $2]; P = .05). Differential reductions in spending on physician services (-$67/quarter [95\% CI, -$134 to -$5]; P = .03) were not associated with differential changes in outpatient visits (-0.06 visits/quarter [95\% CI, -0.21 to 0.08]; P = .37), suggesting reduced spending on inpatient physician services for beneficiaries with limited prior drug coverage. In contrast, nondrug medical spending in the control cohort did not differentially change after January 1, 2004, for beneficiaries with limited prior drug coverage in 2002 ($14/quarter [95\% CI, -$338 to $324]; P = .93), relative to beneficiaries with generous prior coverage.

CONCLUSION: Implementation of Part D was associated with significant differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.

}, keywords = {Aged, Aged, 80 and over, Cost Control, Costs and Cost Analysis, Data collection, Female, Health Expenditures, Health Services, Humans, Insurance Claim Review, Longitudinal Studies, Male, Medicare Part D, Patient Care, Physicians, Skilled Nursing Facilities, United States}, issn = {1538-3598}, doi = {10.1001/jama.2011.1026}, author = {J. Michael McWilliams and Alan M. Zaslavsky and Haiden A. Huskamp} } @article {7380, title = {Financial status, employment, and insurance among older cancer survivors.}, journal = {J Gen Intern Med}, volume = {24 Suppl 2}, year = {2009}, month = {2009 Nov}, pages = {S438-45}, publisher = {24}, abstract = {

BACKGROUND: Few data are available about the socioeconomic impact of cancer for long-term cancer survivors.

OBJECTIVES: To investigate socioeconomic outcomes among older cancer survivors compared to non-cancer patients.

DATA SOURCE: 2002 Health and Retirement Study.

STUDY DESIGN: We studied 964 cancer survivors of > 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans ages >or= 55 years responding to the 2002 Health and Retirement Study.

MEASURES: We compared household income, housing assets, net worth, insurance, employment, and future work expectations.

ANALYSES: Propensity score methods were used to control for baseline differences between cancer survivors and controls.

RESULTS: Female cancer survivors did not differ from non-cancer patients in terms of income, housing assets, net worth, or likelihood of current employment (all P > 0.20); but more were self-employed (25.0\% vs. 17.7\%; P = 0.03), and fewer were confident that if they lost their job they would find an equally good job in the next few months (38.4\% vs. 45.9\%; P = 0.03). Among men, cancer survivors and noncancer patients had similar income and housing assets (both P >or= 0.10) but differed somewhat in net worth (P = 0.04). Male cancer survivors were less likely than other men to be currently employed (25.2\% vs. 29.7\%) and more likely to be retired (66.9\% vs. 62.2\%), although the P value did not reach statistical significance (P = 0.06). Men were also less optimistic about finding an equally good job in the next few months if they lost their current job (33.5\% vs. 46.9\%), although this result was not significant (P = 0.11).

CONCLUSIONS: Despite generally similar socioeconomic outcomes for cancer survivors and noncancer patients ages >or=55 years, a better understanding of employment experience and pessimism regarding work prospects may help to shape policies to benefit cancer survivors.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Data collection, Employment, Female, Financing, Personal, Humans, Income, Insurance Coverage, Insurance, Health, Longitudinal Studies, Male, Middle Aged, Neoplasms, Socioeconomic factors, Survivors}, issn = {1525-1497}, doi = {10.1007/s11606-009-1034-5}, author = {Norredam, Marie and Meara, Ellen and Landrum, Mary Beth and Haiden A. Huskamp and Nancy L. Keating} } @article {7044, title = {Physical and mental health status of older long-term cancer survivors.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Dec}, pages = {2145-52}, publisher = {53}, abstract = {

OBJECTIVES: To assess the physical and mental health status of older long-term cancer survivors.

DESIGN: Cohort study using propensity score methods to control for baseline differences between cancer survivors and controls.

SETTING: General community population in the United States.

PARTICIPANTS: Nine hundred sixty-four cancer patients who had survived for more than 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans aged 55 and older responding to the 2002 Health and Retirement Study.

MEASUREMENTS: Medical conditions, symptoms, health behaviors, health status, mobility, activities of daily living, mental health diagnoses, self-rated memory, depressive symptoms, cognitive function, and self-reported life expectancy.

RESULTS: Cancer survivors reported higher rates of lung disease (13.9\% vs 9.6\%; P=.001), heart condition (29.3\% vs 22.9\%; P<.001), arthritis (69.4\% vs 59.4\%; P<.001), incontinence (26.6\% vs 19.7\%; P=.001), frequent pain (36.4\% vs 29.4\%; P=.005), and obesity (27.0\% vs 24.2\%; P=.001) than individuals without cancer but lower rates of smoking (12.0\% vs 14.8\%; P=.03). Cancer survivors were less likely than persons without cancer to report excellent or very good health status (37.2\% vs 44.6\%; P<.001) and had more mobility (P<.001) and activity of daily living (P=.01) limitations. Cancer survivors did not differ from persons without cancer in rates of depression or cognitive function (both P>.2) but were less optimistic about their life expectancy (P=.004).

CONCLUSION: The physical health status of older long-term cancer survivors is somewhat worse than that of comparable persons who have never had cancer, but they have surprisingly similar mental health status. Future research is needed to understand factors contributing to poorer health status and identify patients at highest risk of long-term cancer-related problems.

}, keywords = {Aged, Aged, 80 and over, Case-Control Studies, Chronic disease, Cohort Studies, Female, Health Behavior, Health Status, Humans, Logistic Models, Male, Mental Health, Middle Aged, Neoplasms, Survivors, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.00507.x}, author = {Nancy L. Keating and Norredam, Marie and Landrum, Mary Beth and Haiden A. Huskamp and Meara, Ellen} }