Advances in health economics and health services research最新文献_第4页

Medicare Part D turns four: trends in plan design, enrollment, and the impact of the program on beneficiaries. 医疗保险D部分进入第四阶段:计划设计趋势，登记，以及该计划对受益人的影响。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022009

Jack Hoadley, Kosali Simon

{"title":"Medicare Part D turns four: trends in plan design, enrollment, and the impact of the program on beneficiaries.","authors":"Jack Hoadley, Kosali Simon","doi":"10.1108/s0731-2199(2010)0000022009","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022009","url":null,"abstract":"Purpose: As Medicare Part D enters its fifth year, we assess how the supply side of the market has evolved and what research has shown about how Medicare drug coverage has affected consumers.Methods: We conduct descriptive data analyses to explore the varied nature of Medicare standalone prescription drug plans (in terms of both price and non-price features), examine features associated with high enrollment, and show trends over time in both plan design and enrollment patterns from 2006 to 2010. We also review existing evidence about Part D's effects on drug access for beneficiaries and conclude with a discussion of current policy concerns.Findings: Medicare Part D has been successful in certain ways, but several areas of concern remain. Although it is a measure of success that 90% of Medicare beneficiaries now have drug coverage, efforts continue to reach the vulnerable populations who are not yet signed up. Use of medications (and relative use of generics) has increased under the program, while out of pocket costs have fallen. Policymakers continue to question government's role in areas such as negotiating prices directly with pharmaceutical manufacturers and limiting the number of plans offered. Results from data analysis indicate, among other things, high growth in premiums, whereas plans have become less generous by certain measures.Originality: This chapter brings together data on all plans offered in Medicare Part D standalone drug coverage market and shows new evidence on the landscape's rapid evolution.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"123-47"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29080197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Pharmaceutical policies in European countries. 欧洲国家的医药政策。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022004

Pedro Pita Barros

{"title":"Pharmaceutical policies in European countries.","authors":"Pedro Pita Barros","doi":"10.1108/s0731-2199(2010)0000022004","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022004","url":null,"abstract":"Purpose: Pharmaceutical expenditures have an important role in Europe. The attempts to control expenditure have used a wide range of policy measures. We reviewed the main measures adopted by the European Union countries, especially in countries where governments are the largest third-party payers.Methodology: To complement a literature review on the topic, data was gathered from national reviews of health systems and direct inquiries to several government bodies.Findings: Almost all countries regulate prices of pharmaceutical products. Popular policy measures include international referencing to set prices (using as benchmark countries that have set lower prices), internal reference pricing systems to promote price competition in domestic markets, and positive lists for reimbursement to promote consumption of generics (including in some cases substitution by pharmacists of drugs prescribed by physicians). Despite the wide range of policy measures, it is not possible to identify a \"silver bullet\" to control pharmaceutical expenditures. We also identified two main policy challenges: policy coordination among countries within the European Union to maintain incentives for R&D at the global level, and the development of new relationships with the pharmaceutical industry; namely, the so-called risk-sharing agreements between the pharmaceutical industry and governments/regulators (or large third-party payers).","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"3-27"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29078104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 35

Drug prices, out-of-pocket payments, and insurer costs: how do payers vary? 药品价格、自付费用和保险费用:支付者如何变化?

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022013

Jie Chen, John A Rizzo

{"title":"Drug prices, out-of-pocket payments, and insurer costs: how do payers vary?","authors":"Jie Chen, John A Rizzo","doi":"10.1108/s0731-2199(2010)0000022013","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022013","url":null,"abstract":"Purpose: To examine how drug prices for specific diseases vary across payers in the United States and how insurer and patient out-of-pocket (OOP) costs vary by payer type.Methodology: This study uses data from the Medical Expenditure Panel Survey (MEPS) from 1996 to 2006. We estimate multivariate price regressions for four major drug product classes (antihypertensive, antidepressant, antiasthma drugs, and non-steroidal anti-inflammatory drugs (NSAIDs)). Separate models are estimated for brand and generic drugs within each of these drug product classes. In addition to estimating overall transaction price equations for brands and generics, the study estimates patient OOP payments and insurer payments for drugs.Findings: We find relatively modest differences among payers in terms of total prices (e.g., insurer plus OOP). The main difference is in terms of how prices were shared between insurers and patients. Medicaid paid significantly more than other payers for each drug class, while Medicaid beneficiaries paid significantly less.Research implications: Our results shed light on how drug prices vary by different payers and how drug prices are shared by third party payers and patients. The relatively modest differences in total drug prices across payer type suggest that these payers do not differ greatly in terms of their ability to negotiate price concessions from their suppliers. Instead, larger differences emerge in terms of how total costs are shared among the payer and their patients. Understanding the reasons for these variations, and their implications for health outcomes, are important directions for further research.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"221-31"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29080201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

The effect of drug vintage on survival: micro evidence from Puerto Rico's Medicaid program. 药物对生存的影响:来自波多黎各医疗补助计划的微观证据。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022015

Frank R Lichtenberg

引用次数: 10

Patents, innovation, and the welfare effects of Medicare Part D. 专利、创新和医疗保险D部分的福利效应。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022017

Adam Gailey, Darius Lakdawalla, Neeraj Sood

{"title":"Patents, innovation, and the welfare effects of Medicare Part D.","authors":"Adam Gailey, Darius Lakdawalla, Neeraj Sood","doi":"10.1108/s0731-2199(2010)0000022017","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022017","url":null,"abstract":"Purpose: To evaluate the efficiency consequences of the Medicare Part D program.Methods: We develop and empirically calibrate a simple theoretical model to examine the static and the dynamic welfare effects of Medicare Part D.Findings: We show that Medicare Part D can simultaneously reduce static deadweight loss from monopoly pricing of drugs and improve incentives for innovation. We estimate that even after excluding the insurance value of the program, the welfare gain of Medicare Part D roughly equals its social costs. The program generates $5.11 billion of annual static deadweight loss reduction and at least $3.0 billion of annual value from extra innovation.Implications: Medicare Part D and other public prescription drug programs can be welfare-improving, even for risk-neutral and purely self-interested consumers. Furthermore, negotiation for lower branded drug prices may further increase the social return to the program.Originality: This study demonstrates that pure efficiency motives, which do not even surface in the policy debate over Medicare Part D, can nearly justify the program on their own merits.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"317-44"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29077917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Cost sharing, benefit design, and adherence: the case of multiple sclerosis. 费用分担，福利设计和坚持:多发性硬化症的案例。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022011

Avi Dor, Maureen J Lage, Marcy L Tarrants, Jane Castelli-Haley

{"title":"Cost sharing, benefit design, and adherence: the case of multiple sclerosis.","authors":"Avi Dor, Maureen J Lage, Marcy L Tarrants, Jane Castelli-Haley","doi":"10.1108/s0731-2199(2010)0000022011","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022011","url":null,"abstract":"Purpose: The authors focus on understanding the relationship between costs and cost sharing on medication adherence for individuals who initiated a disease-modifying therapy (DMT) for the treatment of multiple sclerosis (MS). DMTs reduce the risk of relapse and are an essential component of MS treatment. Furthermore, the authors compare monthly payment levels for copayments versus coinsurance and estimate the effects on adherence.Methods: Using the MarketScan Commercial Claims and Encounters database evidence from July 1 2005 to March 31 2008, the authors employ a multivariate two-stage least-squares model (2SLS) to examine the impact of copayments or coinsurance on the medication possession ratio (MPR).Findings: Descriptive results show that the mean out-of-pocket (OOP) costs of DMT per month were higher for patients with coinsurance than for patients with copayments. For the cohort of patients with copayment there was little difference in monthly copayments across adherence thresholds. Regression analysis shows that an increase in cost sharing reduces adherence overall, but this effect was small and insignificant in the copayment cohort. In contrast, in the coinsurance cohort increased cost sharing was significantly associated with decreased adherence to DMT medication; with a 10% increase in cost sharing leading to an 8.6% decline in adherence.Implications: Employers increasingly rely on coinsurance, despite evidence that reliance on coinsurance results in lower adherence. Our research findings suggest that coinsurance appears to be a greater obstacle to compliance, confirming predictions found in the theoretical literature.Originality: This research converted counts of injectable treatments into a continuous adherence measure. Previous literature on cost sharing did not examine MS.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"175-93"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29080199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 38

Retail pharmacy market structure and insurer-independent pharmacy bargaining in the Medicare Part D era. 医疗保险D部分时代的零售药房市场结构和独立于保险公司的药房议价。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022016

Yang Xie, John M Brooks, Julie M Urmie, William R Doucette

{"title":"Retail pharmacy market structure and insurer-independent pharmacy bargaining in the Medicare Part D era.","authors":"Yang Xie, John M Brooks, Julie M Urmie, William R Doucette","doi":"10.1108/s0731-2199(2010)0000022016","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022016","url":null,"abstract":"Objective: To examine whether local area pharmacy market structure influences contract terms between prescription drug plans (PDPs) and pharmacies under Part D.Data: Data were collected and compiled from four sources: a national mail survey to independent pharmacies, National Councilfor Prescription Drug Programs (NCPDP) Pharmacy database, 2000 U.S. Census data, and 2006 Economic Census data.Results: Reimbursements varied substantially across pharmacies. Reimbursement for 20mg Lipitor (30 tablets) ranged from $62.40 to $154.80, and for 10mg Lisinopril (30 tablets), it ranged from $1.05 to $18. For brand-name drug Lipitor, local area pharmacy ownership concentration had a consistent positive effect on pharmacy bargaining power across model specifications (estimates between 0.084 and 0.097), while local area per capita income had a consistent negative effect on pharmacy bargaining power across specifications(-0.149 to -0.153). Few statistically significant relationships were found for generic drug Lisinopril.Conclusion: Significant variation exists in PDP reimbursement and pharmacy bargaining power with PDPs. Pharmacy bargaining power is negatively related to the competition level and the income level in the area. These relationships are stronger for brand name than for generics. As contract offers tend to be non-negotiable, variation in reimbursements and pharmacy bargaining power reflect differences in initial insurer contract offerings. Such observations fit Rubinstein's subgame perfect equilibrium model.Implication: Our results suggest pharmacies at the most risk of closing due to low reimbursements are in areas with many competing pharmacies. This implies that closures related to Part D changes will have limited effect on Medicare beneficiaries' access to pharmacies.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"295-316"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29077916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

International experience with comparative effectiveness research: case studies from England/Wales and Germany. 比较有效性研究的国际经验:来自英格兰/威尔士和德国的案例研究。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022005

John F P Bridges, Joshua P Cohen, Peter G Grist, Axel C Mühlbacher

{"title":"International experience with comparative effectiveness research: case studies from England/Wales and Germany.","authors":"John F P Bridges, Joshua P Cohen, Peter G Grist, Axel C Mühlbacher","doi":"10.1108/s0731-2199(2010)0000022005","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022005","url":null,"abstract":"Purpose: Although the US has lagged behind international developments in health technology assessment (HTA), renewed interest in HTA in the US has been fueled by the appropriation of $1.1 billion comparative effectiveness research (CER) in 2009 and the debate over health care reform.Approach: To inform CER practices in the US, we present case studies of HTA from England/Wales and Germany: contrasting methods; relevance to the US; and impact on innovation.Findings: The National Institute of Health and Clinical Excellence (NICE) was established in 1999 to inform trusts within the National Health Service of England and Wales. It uses cost-effectiveness analysis to guide the allocation resource across preventative and curative interventions. In Germany, the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) was established in 2004 to inform reimbursement and pricing policies for the statutory sickness funds set by the Gemeinsamer Bundesaursschuss (G-BA). IQWiG evaluates competing technologies within specific therapeutic areas, placing more weight on clinical evidence and the relative efficiency of competing therapies.Practical implications: Although having deep political and cultural antecedents, differences between NICE and IQWiG can be explained by perspective: the former guiding resource allocation across an entire system (macro-evaluation), the latter focusing on efficiency within the bounds of a particular therapeutic area (micro-evaluation). Given the decentralized nature of the US health care system, and the relative powers of different medical specialties, the IQWiG model presents a more suitable case study to guided CER efforts in the US.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"29-50"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29078105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 21

Global budgets and provider incentives: hospitals' drug expenditures in Taiwan. 全球预算与提供者激励:台湾医院药品支出。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022008

Shin-Yi Chou, Mary E Deily, Hsien-Ming Lien, Jing Hua Zhang

{"title":"Global budgets and provider incentives: hospitals' drug expenditures in Taiwan.","authors":"Shin-Yi Chou, Mary E Deily, Hsien-Ming Lien, Jing Hua Zhang","doi":"10.1108/s0731-2199(2010)0000022008","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022008","url":null,"abstract":"Purpose: This chapter examines how drug prescribing behavior in Taiwanese hospitals changed after the government changed reimbursement systems. In 2002, Taiwan instituted a system in which hospitals are reimbursed for drug expenditures at full price from a fixed global budget before the remaining budget is allocated to reimburse all other expenditures, often at discounted prices. Providers are thus given a financial incentive to increase prescriptions.Methodology: We isolate the effect of this system from that of other confounding factors by estimating a difference-in-difference model to analyze monthly drug expenditures of hospital departments for outpatients during the years 1999-2006.Findings: Our results suggest that hospital departments which use drugs more heavily as part of their regular medical care increased their drug prescription expenditures after the implementation of the global budget system. In addition, we find that the response was stronger among for-profit than not-for-profit and public hospitals.Implications: Hospital doctors responded to the financial incentive created by the particular global budgeting system adopted in Taiwan by increasing expenditures on drug treatments for outpatients.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"103-22"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29080196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Adverse selection and the effect of health insurance on utilization of prescribed medicine among patients with chronic conditions. 逆向选择及健康保险对慢性病患者处方药使用的影响。

Advances in health economics and health services research Pub Date : 2010-01-01 DOI: 10.1108/s0731-2199(2010)0000022014

Yuriy Pylypchuk

{"title":"Adverse selection and the effect of health insurance on utilization of prescribed medicine among patients with chronic conditions.","authors":"Yuriy Pylypchuk","doi":"10.1108/s0731-2199(2010)0000022014","DOIUrl":"https://doi.org/10.1108/s0731-2199(2010)0000022014","url":null,"abstract":"Purpose: To examine the effects of health insurance types on the use of prescribed medication that treat patients with hypertension, diabetes, and asthma. The study distinguishes between individuals with private health maintenance organization (HMO) plans and private non-HMO plans. The study also distinguishes between people with health insurance and drug coverage and people with health insurance and no drug coverage.Methods: Joint discrete factor models are estimated to control for endogeneity of each type of coverage.Findings: The main findings suggest that the effect of health insurance varies across patients with different conditions. The strongest and most significant effect is evident among patients with hypertension while the weakest and least significant is among patients with asthma. These findings suggest that patients with asymptomatic conditions are more likely to exhibit moral hazard than patients with conditions that impose immediate impairment. Additional results suggest that, relative to the uninsured and people with health insurance but no drug coverage, patients with drug coverage are more likely to initiate drug therapy and to consume more medications.Originality: The results of the study indicate that moral hazard of drug utilization is condition specific. The variation in \"silence\" of conditions' symptoms could be a key reason for difference in insurance effects among patients with hypertension, diabetes, and asthma.","PeriodicalId":79553,"journal":{"name":"Advances in health economics and health services research","volume":"22 ","pages":"233-72"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/s0731-2199(2010)0000022014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29080202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4