Medicare policy change led to higher drug spending

2013 ◽  
Vol 43 (1) ◽  
pp. 54
Author(s):  
MARY ELLEN SCHNEIDER
2006 ◽  
Vol 24 (1) ◽  
pp. 141-144 ◽  
Author(s):  
Joseph M. Unger ◽  
Charles A. Coltman ◽  
John J. Crowley ◽  
Laura F. Hutchins ◽  
Silvana Martino ◽  
...  

Purpose A prior analysis by the Southwest Oncology Group (SWOG) showed that women and African American patients were adequately represented on cancer clinical treatment trials but that older patients were substantially underrepresented. Twenty-five percent of patients ≥ 65 years old were enrolled onto SWOG trials from 1993 to 1996, whereas 63% of all patients with cancer were ≥ 65 years old. Recognition of this under-representation led to a change in Medicare policy in 2000 to include coverage of routine patient care costs of clinical trials. We conducted an updated analysis of accrual trends. Methods The proportions of enrollment onto SWOG treatment trials by sex, race/ethnicity, and age (≥ 65 years) were computed for the years 1997 to 2000; corresponding rates in the United States were derived from US Census and National Cancer Institute Surveillance, Epidemiology, and End Results data. Additionally, method of payment data were analyzed over time (1993 to 2003) to assess whether patterns in method of payment changed with the new Year 2000 Medicare policy on clinical trials coverage. Results The results showed continued adequate representation by sex and race/ethnicity. Older patient accrual on SWOG trials increased significantly since 2000, with 31% of patients ≥ 65 years old enrolled from 1997 to 2000 and 38% enrolled from 2001 to 2003 (v 25% from 1993 to 1996). The percentage of patients using Medicare plus supplemental insurance also increased beginning in 2000, whereas the percentage of patients using Medicare alone remained the same. Conclusion Method of payment analyses provided evidence that the Year 2000 Medicare policy change had a positive impact, but only for those patients with supplemental private coverage of coinsurance costs. Improvements in the Medicare payment structure could further increase older patient participation in clinical trials.


2019 ◽  
Vol 60 (1) ◽  
pp. 3-17 ◽  
Author(s):  
Cindy L. Cain

There is no doubt that the organization of healthcare is currently shifting, partly in response to changing macrolevel policies. Studies of healthcare policies often do not consider healthcare workers’ experiences of policy change, thus limiting our understanding of when and how policies work. This article uses longitudinal qualitative data, including participant observation and semistructured interviews with workers within hospice care as their organizations shifted in response to a Medicare policy change. Prior to the policy change, I find that the main innovation of hospice—the interdisciplinary team—is able to resist logics from the larger medical institution. However, when organizational pressures increase, managers and workers adjust in ways that reinforce medical logics and undermine the interdisciplinary team. These practices illustrate processes by which rationalization of healthcare affects workers’ experiences and the type of care available to patients.


Author(s):  
Arwanto Arwanto ◽  
Wike Anggraini

ABSTRACT Understanding policy process involves many distinctive approaches. The most common are institutional, groups or networks, exogenous factors, rational actors, and idea-based approach. This paper discussed the idea-based approach to explain policy process, in this case policy change. It aims to analyse how ideas could assist people to understand policy change. What role do they play and why are they considered as fundamental element? It considers that ideas are belong to every policy actor, whether it is individual or institution. In order to answer these questions, this paper adopts Kingdon’s multi streams approach to analyse academic literatures. Through this approach, the relationship between ideas and policy change can be seen clearer. Ideas only can affect in policy change if it is agreed and accepted by policy makers. Therefore the receptivity of ideas plays significant role and it emerges policy entrepreneurs. They promote ideas (through problem framing, timing, and narrative construction) and manipulate in order to ensure the receptivity of ideas. Although policy entrepreneurs play significant role, political aspects remains the most important element in the policy process. Keywords: policy change, ideas, idea-based approach, Kingdon’s multiple streams, policy entrepreneurs.


2018 ◽  
Vol 9 (4) ◽  
pp. 325-342 ◽  
Author(s):  
Il-Young Oh ◽  
Young Chai Yoon
Keyword(s):  

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