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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Neil Jordan, PhD, Dept of Mental Health Law & Policy, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL 33612, 813-974-9243, njordan@fmhi.usf.edu
RESEARCH OBJECTIVE: Prescription drug expenditures in state Medicaid programs have risen at rates far exceeding inflation during the past decade. Instituting copayments for Medicaid prescription drugs has been a cost-containment strategy implemented by states, and studies have shown that beneficiary cost sharing has led to a decrease in prescription drug utilization. What is unclear is the effect of copayments on utilization of other “substitute” medical services such as hospitalization, particularly for patients with chronic illness. Failure to fill drug prescriptions due to copayments may lead to acute health incidents that require subsequent hospitalization, which is free to the beneficiary but less cost-effective than drug therapy. This paper examines the relationship between Medicaid drug copayment policy and two types of hospital utilization (emergency room [ER] and inpatient) in a population of patients with end-stage renal disease (ESRD). STUDY DESIGN: The sample includes 14,360 dialysis patients from 31 states who were continuously dually enrolled in fee-for-service Medicare and Medicaid during 1995. Children and patients enrolled in managed care plans were excluded. Demographic data were drawn from the Medicare Enrollment Database and the ESRD Patient Profile; utilization data came from Medicare claims. Of the 14,360 patients, 1,251 resided in states with a sliding scale for prescription drug copayments (e.g., $.50-$3.00 per RX per month, depending upon drug cost); 6,504 lived in states with a flat copayment rate (e.g., $1 per RX per month); 6,605 faced no drug copayments. Sliding scale copayments lead to higher average out-of-pocket expenditures than flat rate copayments. The ER and inpatient utilization equations were both analyzed using negative binomial regression; both models also controlled for illness severity and other Medicaid drug benefit policies. PRINCIPAL FINDINGS: Patients living in states with sliding scale drug copayments had a higher incidence rate of ER visits than patients who did not face drug copayments. Conversely, patients living in states with flat rate drug copayments had a lower incidence rate of ER visits than patient who did not face drug copayments. Copayment policy was not significantly related to inpatient use. Other significant predictors in both models included being female, changing dialysis modality during the year, and Charlson comorbidity index. IMPLICATIONS: The relationship between drug copayment policy and hospital utilization for acute events is ambiguous. There is little evidence that nominal cost sharing for prescription drugs leads to adverse outcomes in low-income persons with ESRD, and flat rate copayments may lead to lower ER use.
Learning Objectives: At the end of the presentation, participants will be able to
Keywords: Access to Health Care, Medicaid
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.