scholarly journals Racial and Ethnic Differences in Preventive Services Use After the Affordable Care Act’s Enhancement of Medicare Benefits

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 98-98
Author(s):  
Mohammad Usama Toseef ◽  
Wassim Tarraf
Keyword(s):  
Cost Sharing ◽  
Medical Expenditure Panel Survey ◽  
Ethnic Disparities ◽  
Preventive Services ◽  
Clinical Breast Examination ◽  
Medical Expenditure ◽  
Medicare Beneficiaries ◽  
Racial And Ethnic Differences ◽  
Targeted Interventions ◽  
The Impact

Abstract As a consequence of the Affordable Care Act’s enhancements of Medicare benefits, certain recommended clinical preventive services became available to Medicare beneficiaries without cost-sharing. We study the impact of these mandates on racial/ethnic disparities in the use of preventive services among traditional Medicare beneficiaries. We analyze nationally representative data on non-institutionalized Medicare seniors from the 2006-2016 Medical Expenditure Panel Survey (N=27,124). Our preventive services of interest include yearly receipt of cholesterol check, blood pressure test, flu shot, endoscopy, blood stool test, clinical breast examination, mammography and prostate exam. We estimate propensity score weighted difference-in-difference (DID) models to test for differences in preventive services utilization by race/ethnicity. Among traditional Medicare beneficiaries, we do not observe significant change in the use of most preventive services for Blacks and Hispanics compared to their White counterparts. However, Hispanics have significantly increased their use of blood stool tests relative to whites. Overall, we do not find major evidence to support a differential effect of reforms on race/ethnic minorities’ uptake of preventive services following the mandates. Our results suggest that despite an overall benefit trough services expansion and cost-sharing elimination race/ethnic group differences persist. As such, disparities might continue and would require additional interventions. Reduction in disparities is a stated goal of US policy for many decades and achieving equity might require additional work and more varied and targeted interventions.

scholarly journals Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive limitation or Alzheimer's disease and related dementias: a retrospective cohort study

2020 ◽  
Author(s):  
Sungchul Park ◽  
Jie Chen
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Medical Expenditure Panel Survey ◽  
Health Care Expenditures ◽  
Medical Expenditure ◽  
Medicare Beneficiaries ◽  
Racial And Ethnic Differences

Abstract Background: Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer's disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive limitation without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service.Methods: We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive limitation, those with cognitive limitation without ADRD, and those with ADRD. Using the 1996-2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive limitation, those with cognitive limitation without ADRD and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics.Results: Asians, and Latinos without cognitive limitation had lower total health care expenditures than whites without cognitive limitation ($10236, $9497, $9597, and $11541, respectively), but there were no racial and ethnic differences in total health care expenditures among those with cognitive limitation without ADRD and those with ADRD. In all populations, however, blacks, Asians, and Latinos tended to have lower out-of-pocket expenditures than whites (except for Asians with cognitive limitation without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups.Conclusions: Our findings may suggest that racial and ethnic minority groups did not experience limited access to care before and after ADRD diagnosis. Differences in out-of-pocket expenditures and service-specific expenditures may be attributable to racial and ethnic differences in care access and/or care preference based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.

scholarly journals Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer’s disease and related dementias

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sungchul Park ◽  
Jie Chen
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Cognitive Deficits ◽  
Health Care Expenditures ◽  
Medical Expenditure ◽  
Medicare Beneficiaries ◽  
Racial And Ethnic Differences

Abstract Background Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer’s disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service. Methods We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996–2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics. Results Black, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9497, $9597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups. Conclusions Our study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.

Impact of FDA Black Box Warning on Psychotropic Drug Use in Noninstitutionalized Elderly Patients Diagnosed With Dementia

2016 ◽  
Vol 29 (5) ◽  
pp. 495-502 ◽  
Author(s):  
Rakesh R. Singh ◽  
Rajesh Nayak
Keyword(s):  
Elderly Patients ◽  
Medical Expenditure Panel Survey ◽  
Medication Use ◽  
Black Box ◽  
Medical Expenditure ◽  
Bivariate Analysis ◽  
Minimal Impact ◽  
Actual Use ◽  
Long Term Impact ◽  
The Impact

Background: The study seeks to investigate the impact of Food and Drug Administration's black box warning (BBW) on the use of atypical antipsychotics (AAP) and nonantipsychotic psychotropic alternatives in noninstitutionalized elderly population diagnosed with dementia. Method: The Medical Expenditure Panel Survey (2004 through 2007) was utilized as the data source. Medication use in elderly patients (≥65 years) was defined as taking at least 1 medication for dementia. We performed a statistical comparison of prewarning (2004-2005) and postwarning (2006-2007) periods with respect to AAP and nonantipsychotic psychotropic use to examine the impact of labeling changes. Results: A bivariate analysis did not yield statistically significant change in either the AAP or nonantipsychotic psychotropic use, pre- versus postwarning. However, multivariate logistic-regression analyses revealed greater odds for antidementia (odds ratio [OR] = 1.976, P = .0195) and benzodiazepine (OR = 3.046, P = .0227) medication use in postwarning period compared to the prewarning period. Conclusion: The regulatory warnings and labeling changes regarding off-label use of AAPs in dementia treatment showed minimal impact on their actual use in noninstitutionalized populations. A corresponding increase in the use of nonantipsychotic psychotropics explains that BBW might have resulted in a compensatory shift in favor of benzodiazepines and antidementia medications. Additional research should be conducted to examine the long-term impact of BBW on antipsychotic prescribing changes.

scholarly journals National Trends in Out-of-Pocket 1 Costs Among U.S. Adults With Diabetes Aged 18–64 Years: 2001–2017

2021 ◽  
Author(s):  
Yu Wang ◽  
Joohyun Park ◽  
Rui Li ◽  
Elizabeth Luman ◽  
Ping Zhang
Keyword(s):  
Medical Expenditure Panel Survey ◽  
Drug Prescription ◽  
Private Insurance ◽  
The United States ◽  
Medical Expenditure ◽  
Complication Rates ◽  
Poverty Level ◽  
Cost Rate ◽  
National Trends ◽  
The Impact

<b>Objective</b> <p>To assess national trends in out-of-pocket (OOP) costs among adults aged 18–64 years with diabetes in the United States. </p> <p><b>Research design and methods</b></p> <p>Using data from the 2001–2017 Medical Expenditure Panel Survey, we estimated total per person annual OOP costs (insurance premiums, prescription drug costs, inpatient and outpatient deductibles, and copays, and other payments not covered by insurance) and high OOP cost rate defined as the percentage of people with OOP spending more than 10% of their family’s pretax income. We examined trends overall, by subgroup (insurance type, income level, insulin use, size of patient’s employer, and whether the patient was enrolled in a high deductible health plan), and by type of service. Changes in trends were identified using joinpoint analysis; costs were adjusted to 2017 US dollars.</p> <p><b>Results</b></p> <p>From 2001 to 2017, OOP costs decreased 4.3%, from $4,328 to $4,139, and high OOP cost rate fell 32%, from 28% to 19% (<i>P</i> < 0.001). Changes in the high OOP cost rate varied by subgroup, declining among those with public or no insurance and those with an income <200% of the federal poverty level (<i>P</i> < 0.001), but remaining stable among those with private insurance and higher income. Drug prescription OOP costs decreased among all subgroups (<i>P</i> < 0.001). Decreases in total (-$58 vs -$37, <i>P</i> < 0.001) and prescription (-$79 vs -$68, <i>P</i> < 0.001) OOP costs were higher among insulin users than noninsulin users. </p> <p><b>Conclusions</b></p> OOP costs among US nonelderly adults with diabetes declined, especially among those least able to afford them. Future studies may explore factors contributing to the decline in OOP costs and the impact on the quality of diabetes care and complication rates.

scholarly journals National Trends in Out-of-Pocket 1 Costs Among U.S. Adults With Diabetes Aged 18–64 Years: 2001–2017

2021 ◽  
Author(s):  
Yu Wang ◽  
Joohyun Park ◽  
Rui Li ◽  
Elizabeth Luman ◽  
Ping Zhang
Keyword(s):  
Medical Expenditure Panel Survey ◽  
Drug Prescription ◽  
Private Insurance ◽  
The United States ◽  
Medical Expenditure ◽  
Complication Rates ◽  
Poverty Level ◽  
Cost Rate ◽  
National Trends ◽  
The Impact

<b>Objective</b> <p>To assess national trends in out-of-pocket (OOP) costs among adults aged 18–64 years with diabetes in the United States. </p> <p><b>Research design and methods</b></p> <p>Using data from the 2001–2017 Medical Expenditure Panel Survey, we estimated total per person annual OOP costs (insurance premiums, prescription drug costs, inpatient and outpatient deductibles, and copays, and other payments not covered by insurance) and high OOP cost rate defined as the percentage of people with OOP spending more than 10% of their family’s pretax income. We examined trends overall, by subgroup (insurance type, income level, insulin use, size of patient’s employer, and whether the patient was enrolled in a high deductible health plan), and by type of service. Changes in trends were identified using joinpoint analysis; costs were adjusted to 2017 US dollars.</p> <p><b>Results</b></p> <p>From 2001 to 2017, OOP costs decreased 4.3%, from $4,328 to $4,139, and high OOP cost rate fell 32%, from 28% to 19% (<i>P</i> < 0.001). Changes in the high OOP cost rate varied by subgroup, declining among those with public or no insurance and those with an income <200% of the federal poverty level (<i>P</i> < 0.001), but remaining stable among those with private insurance and higher income. Drug prescription OOP costs decreased among all subgroups (<i>P</i> < 0.001). Decreases in total (-$58 vs -$37, <i>P</i> < 0.001) and prescription (-$79 vs -$68, <i>P</i> < 0.001) OOP costs were higher among insulin users than noninsulin users. </p> <p><b>Conclusions</b></p> OOP costs among US nonelderly adults with diabetes declined, especially among those least able to afford them. Future studies may explore factors contributing to the decline in OOP costs and the impact on the quality of diabetes care and complication rates.

Sign in / Sign up

Export Citation Format

Share Document