Impact of Medicare Part D on Prescription Use, Health Care Expenditures, and Health Services Utilization: National Estimates for Medicare Beneficiaries, 2002 to 2009

Abstract Evidence supports the potential for e-prescribing to reduce the incidence of adverse drug events (ADEs) in hospital-based studies, but studies in the ambulatory setting have not used occurrence of ADE as their outcome. Using the “prescription origin code” in 2011 Medicare Part D prescription drug events files, the authors investigate whether physicians who meet the meaningful use stage 2 threshold for e-prescribing (≥50% of prescriptions e-prescribed) have lower rates of ADEs among their diabetic patients. Risk of any patient with diabetes in the provider’s panel having an ADE from anti-diabetic medications was modeled adjusted for prescriber and patient panel characteristics. Physician e-prescribing to Medicare beneficiaries was associated with reduced risk of ADEs among their diabetes patients (Odds Ratio: 0.95; 95% CI, 0.94-0.96), as were several prescriber and panel characteristics. However, these physicians treated fewer patients from disadvantaged populations.

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Cost-Related Non-Utilization of Health Services and Self-Perceived Reactions to Race

Ethnicity & Disease ◽

10.18865/ed.30.3.399 ◽

2020 ◽

Vol 30 (3) ◽

pp. 399-410

Author(s):

Eberechukwu Onukwugha ◽

Jacquelyn McRae ◽

Wendy Camelo Castillo

Keyword(s):

Health Care ◽

Health Services ◽

Physician Visit ◽

Health Services Utilization ◽

Physical Symptoms ◽

Limited Information ◽

Cross Sectional ◽

Physician Visits ◽

Care Experience ◽

Services Utilization

Purpose: There is limited information regarding the prevalence and predictors of cost-related non-utilization (CRNU), while there is increasing attention to the rising out-of-pocket cost of health services including prescription medications. Prior studies have not quantified the role of perceived racism despite its documented relationship with health services utilization. We examine perceptions of reactions to race and quantify their relationship with CRNU.Methods: This retrospective cross-sectional study utilized data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) public use file, an annual, state-based telephone survey of US adults aged 18 and older. We utilized data for four states that provided responses to five Reactions to Race items, including information about the self-perceived quality of the respondent’s health care experience compared with people of other races (worse vs same or better) and whether the respondent experienced physical symptoms because of treatment due to their race. The three binary outcomes were: 1) did not visit a physician; 2) did not visit a physician due to cost; 3) did not fill a prescription due to cost. We estimated covariate-adjusted odds ratios associated with each outcome using logistic regression models.Results: The BRFSS sample consisted of 20,366 respondents of whom 8% were African American non-Hispanic, 12% were Hispanic and 73% were White. Three percent of respondents considered their experience to be worse than people of other races. Three percent of individuals reported physical symptoms because of treatment due to their race while 5% of respondents reported becoming emotionally upset because of treatment due to their race. The proportions for the three study outcomes were 11%, 13% and 7%, respectively. In covariate-adjusted models, a worse experience with the health care system was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.6 – 4.3]). The experience of physical symptoms because of treatment due to race was statistically significantly associated with CRNU (physician visit: 2.6 [95% CI: 1.7 – 4]; prescription fills: 2.1 [1.2 – 3.6]). No Reactions to Race items were associated with general non-utilization.Conclusions: Negative perceptions of reactions to race during the time of health services utilization is positively associated with CRNU, ie, foregoing physician visits and prescription fills due to cost.Ethn Dis. 2020;30(3):399-410; doi:10.18865/ed.30.3.399

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Pemanfaatan Pelayanan Kesehatan Sasaran Program Jaminan Tabalong Sehat di Kabupaten Tabalong Kalimantan Selatan

Jurnal Penelitian dan Pengembangan Pelayanan Kesehatan ◽

10.22435/jpppk.v1i2.552 ◽

2018 ◽

pp. 102-112

Author(s):

Amir Su'udi ◽

Harimat Hendarwan

Keyword(s):

Public Health ◽

Health Care ◽

Health Services ◽

Health Services Utilization ◽

Health Centre ◽

Cross Sectional ◽

Public Health Centre ◽

Health Security ◽

Services Utilization ◽

Free Health Care

Abstrak Pemerintah Kabupaten Tabalong Kalimantan Selatan menerapkan pelayanan kesehatan gratis di Puskesmas melalui program Jaminan Tabalong Sehat (JTS) sejak tahun 2008. Peserta JTS adalah seluruh penduduk Tabalong yang tidak memiliki asuransi atau jaminan kesehatan. Penelitian ini bertujuan mengetahui faktor-faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan di puskesmas. Penelitian ini menggunakan desain cross sectional dan wawancara mendalam. Sampel uji sebanyak 253 rumah tangga sasaran program JTS, diambil dari 405 sampel rumah tangga yang dipilih secara sistematik, dari klaster 15 desa/kelurahan di tiga wilayah puskesmas terpilih. Hasil penelitian menunjukkan bahwa pemanfaatan pelayanan kesehatan gratis di puskesmas belum optimal. Sebanyak 52% rumah tangga pernah memanfaatkan pelayanan kesehatan puskesmas dalam setahun terakhir. Faktor yang berhubungan dengan pemanfaatan pelayanan kesehatan di puskesmas adalah pengetahuan, kemauan untuk membayar/WTP, adanya penyakit tertentu, waktu tempuh, kemudahan dan biaya transportasi. Rendahnya pemanfaatan pelayanan kesehatan di puskemas yang sudah digratiskan disebabkan karena kurang optimalnya kegiatan puskesmas, kurangnya sosialisasi ke masyarakat dan sasaran masyarakat yang disubsidi kurang tepat. Kata kunci: Pemanfaatan pelayanan kesehatan, Puskesmas, Subsidi, Tabalong Abstract Government of Tabalong District have been giving free health care subsidies at public health centre (PHC) through Tabalong Health Security (Jaminan Tabalong Sehat /JTS) program since 2008. Targetting of JTS program are all of Tabalong citizens that have not covered by health insurance or other health security programs. The objective of this research was to know the factors that related with utilization of health services at PHC in Tabalong District. Approach of this research were cross sectional design and deep interview. Sampels were 253 targetting household taken form 405 household that selected by systematic random from 15 villages cluster at three selected PHC areas. The result showed that utilization of free health services subsidies were not optimize yet. Just 52% of household utilized health services at PHC in the last year. The factors that related with health services utilization at PHC are knowledge, willingness to pay (WTP), diseases avalaibility, travelling time, easiness and cost of transportation. The low rates utilization of free health care were also caused by un-optimize of PHC’s activities, lack of promotion the JTS programs, not matching of subsidies targetting. Keywords: Health services utilization, public health centre, subsidy, Tabalong

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