TY - JOUR T1 - Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage. JF - JAMA Y1 - 2011 A1 - J. Michael McWilliams A1 - Alan M. Zaslavsky A1 - Haiden A. Huskamp KW - Aged KW - Aged, 80 and over KW - Cost Control KW - Costs and Cost Analysis KW - Data collection KW - Female KW - Health Expenditures KW - Health Services KW - Humans KW - Insurance Claim Review KW - Longitudinal Studies KW - Male KW - Medicare Part D KW - Patient Care KW - Physicians KW - Skilled Nursing Facilities KW - United States AB -

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.

PB - 306 VL - 306 IS - 4 N1 - McWilliams, J Michael Zaslavsky, Alan M Huskamp, Haiden A Comparative Study Research Support, Non-U.S. Gov't United States JAMA : the journal of the American Medical Association JAMA. 2011 Jul 27;306(4):402-9. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21791689?dopt=Abstract U3 - 21791689 U4 - Aged, 80 and over/Cost Control/Cost Control/Costs and Cost Analysis/Data Collection/Female/Health Expenditures/ trends/Health Expenditures/ trends/Health Services/ economics/utilization/Health Services/ economics/utilization/Humans/Insurance Claim Review/Insurance Claim Review/Longitudinal Studies/Medicare Part D/ economics/Medicare Part D/ economics/Patient Care/ economics/Patient Care/ economics/Physicians/Skilled Nursing Facilities/ economics/Skilled Nursing Facilities/ economics/United States ER - TY - JOUR T1 - Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults JF - Journal of the American Medical Association Y1 - 2003 A1 - J. Michael McWilliams A1 - Alan M. Zaslavsky A1 - Meara, Ellen A1 - John Z. Ayanian KW - Healthcare KW - Medicare/Medicaid/Health Insurance AB - Context Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health.Objective To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults.Design and Setting Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years.Participants A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n=167), intermittently uninsured (n=216), or continuously insured (n=1820) in 1994 and 1996, prior to Medicare eligibility.Main Outcome Measures Individuals' reports of receiving cholesterol testi ng, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years.Results The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4 vs 17.7 ; change of -17.7 95 Cl, -29.3 to -6.2 ; P=.003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2 vs 7.7 ; difference of 21.5 95 Cl, 0.2 to 42.9 1; P=.048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3 vs 15.0 ; change of -15.3 95 Cl, -29.9 to -0.7 1; P=.04) and prostate examination in men (45.2 vs 20.0 ; change of -25.2 95 Cl, -45.4 to -5.1 ; P=.01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eligibility, but not greater increases in arthritis treatments. Among adults with hypertension, differences in use of antihypertensive medications between continuously uninsured and insured adults were essentially unchanged after Medicare coverage.Conclusions Previously uninsured adults substantially increased their use of covered basic clinical services but not medications after gaining Medicare coverage. An affordable option through which near-elderly uninsured adults could purchase Medicare coverage might have similar effects. PB - 290 VL - 290 IS - 6 U4 - Medicare/Health Services/Health Insurance Coverage ER -