Impact of prescription drug coverage on access to healthcare for older adults

In response to the Medicare Part D legislation, the National Center for Health Statistics' National Health Interview Survey (NHIS) added a series of questions concerning prescription drug benefits to capture the impact of changes in Medicare on the quality and delivery of healthcare services. As part of the legislation, an interim Medicare Prescription Drug Discount Card Endorsement Program was operated in 2004 and 2005 prior to the implementation of Medicare Part D in 2006. This paper will explore differences in access to and utilization of healthcare between older adults with and without prescription drug benefits (including the interim card and Medicare Part D) disaggregated according to a person having private health insurance or Medicare only coverage. This study uses the 2005 and 2006 NHIS, which is nationally representative of the U.S. civilian noninstitutionalized population and is conducted as a face-to-face household interview. In 2005, the data analyzed are from a total of 6,078 randomly sampled adults 65+ who provided information about their healthcare access and utilization. These measures include flu/pneumoccal vaccinations, visits to doctors' offices, dental visits, use of medical specialists, unmet medical needs due to cost and non-medical barriers to receiving care. Unmet medical needs is a composite variable that includes the following: delayed or did not obtain needed care due to cost; and needed prescription medication, mental health services, dental care or eyeglasses in the past year but did not get these services due to cost. Non-medical barriers to care include not being able to get through by phone, difficulty obtaining an appointment, long waits in the doctor's office, inconvenient office hours and lack of transportation. In addition to these healthcare measures, selected socio-demographic variables will be incorporated. Preliminary analysis of 2005 data found that 65% of privately insured older adults had a prescription drug benefit as part of their plan. Among persons without private coverage, 13.5% of older adults with Medicaid and 16.1% with only Medicare coverage also had the interim drug card. Privately insured older adults without prescription coverage were more likely to have an unmet prescription need and less likely to have a dental visit in the past year than those with prescription coverage. Persons with only Medicare plus an interim card were less likely to have an eye doctor visit in the past year than those without the card. Impact of Medicare Part D will be explored with 2006 NHIS data.