Do seniors get the medicines prescribed for them? evidence from the 1996-1999 medicare current beneficiary survey

Health Affairs

Volumn 22, Issue 3, 2003, Pages 175-182

  Craig, Benjamin M ^a   Kreling, David H ^b   Mott, David A ^c  

^a UNIVERSITY OF WISCONSIN MADISON   (United States)

^b Hammel/Sanders Professor of Pharmacy Administration   (United States)

^c Sonderegger Research Center   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; CHRONIC DISEASE; COMPARATIVE STUDY; ECONOMICS; EPIDEMIOLOGY; FEMALE; HEALTH INSURANCE; HUMAN; MALE; MEDICARE; PATIENT COMPLIANCE; PRESCRIPTION; STATISTICS; UNITED STATES;

AGED; AGED, 80 AND OVER; CHRONIC DISEASE; FEMALE; HEALTH CARE SURVEYS; HUMANS; INSURANCE, PHARMACEUTICAL SERVICES; MALE; MEDICARE; PATIENT COMPLIANCE; PRESCRIPTIONS, DRUG; UNITED STATES;

EID: 0038387467     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.22.3.175     Document Type: Review

References (18)

1. D. Safran et al., "Prescription Drug Coverage and Seniors: How Well Are States Closing the Gap?" 31 July 2002, www.healthaffairs.org/ WebExclusives/Safran_Web_Excl_073102 (13 February 2003).
2. National Public Radio/Kaiser Family Foundation/Kennedy School of Government, "National Survey on Health Care, Chartpack," June 2002, www.kff.org/content/2002/3238/NPR_Chart_Pack_FINAL2pdf (14 February 2003);
3. and P.J. Cunningham, "Affording Prescription Drugs: Not Just a Problem for the Elderly," Research Report no. 5, April 2002, www.hschange.org/CONTENT/430/430.pdf (14 February 2003).
4. M. Steinman et al., "Self-Restriction of Medications Due to Cost in Seniors without Prescription Drug Coverage," Journal of General Internal Medicine 16, no. 12 (2001): 793-799.
5. J. Kennedy and C. Erb, "Prescription Noncompliance Due to Cost among Adults with Disabilities in the United States," American Journal of Public Health 92, no. 7 (2002): 1120-1124.
6. See, for example, J.A. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries with and without Drug Coverage," Health Affairs (Mar/Apr 2001): 74-85;
7. B. Stuart, D. Shea, and B. Briesacher, "Dynamics in Drug Coverage of Medicare Beneficiaries: Finders, Losers, Switchers," Health Affairs (Mar/Apr 2001): 86-99;
8. and M.A. Laschober et al., "Trends in Medicare Supplemental Insurance and Prescription Drug Coverage, 1996-1999," 27 February 2002, www.healthaffairs.org/WebExclusives/Laschober_Web_Excl_022702.htm (14 February 2003).
9. From a policy perspective, the estimated values are not appreciably different across years. Therefore, we do not report tests of statistical significance. Furthermore, sampling weights included with the MCBS were employed in the calculation of all estimates.
10. We applied a hierarchical protocol to assign a point-in-time measure of drug coverage. In the first step, those entitled to Medicaid were set aside. Second, we removed those who reported having drug coverage through a Medicare or private health maintenance organization (HMO). Third, we removed those with drug coverage through employment or retirement. Those with other forms of private drug coverage were place in the Medigap category. The MCBS does not capture drug benefits from other public sources, such as Veterans Affairs or military retirees. To accommodate for this absence, those with non-Medicaid public supplemental coverage were placed in the other public category, if they had not been assigned in a previous step. The remaining respondents make up the "no drug coverage" group. Bruce Stuart and colleagues reported that nearly 17 percent of beneficiaries had a gap in their drug coverage in 1995, which suggests that respondents may have changed coverage over the recall period. Stuart et al., "Dynamics in Drug Coverage of Medicare Beneficiaries." The variability potentially dilutes the implication of a point-in-time measure of drug coverage.
11. For example, frequent fliers are more likely to experience delays in airports simply because they fly more. There is little evidence that airlines target delays toward frequent fliers, although it feels that way at times.
12. Analogously, one can imagine two studies, each asking whether respondents had difficulty getting an appointment to see a physician. One study asks participants to respond based on past experience, while the second asks respondents to try to make an appointment with their physician and respond accordingly. Respondents with less experience with physician services, such as the healthy, are less likely to report difficulty based on past experience. Thus, the first study, by construction, is likely to find a stronger positive correlation between health and access barriers compared to the second, in which experience is controlled.
13. Some questions have longer lengths of recall, include other aspects of access ("taking," "use" "needed," "decide"), and include the acquisition of family members' medicines. With respect to these attributes, the question in the MCBS is less general, and the differences in questions may have led to the higher estimates found in the previous literature. On the other hand, some studies specified a particular barrier to access, including only nonacquisition because of economic factors. In this regard, the question in the MCBS is more general, because it allows for the presence of multiple reasons. The comparison between results is further challenged by differences in sample sizes, sample representation, data collection methods, and response rates.
14. Safran and colleagues examined data collected from eight states using a mailed survey with a 55 percent response rate, and we examine data collected from all states using in-person interviews with a 94 percent response rate. Safran et al., "Prescription Drug Coverage and Seniors."
15. See, for example, J. Blustein, "Drug Coverage and Drug Purchases by Medicare Beneficiaries with Hypertension," Health Affairs (Mar/Apr 2000): 219-230.
16. See D. Mott and R. Cline, "Exploring Generic Drug Use Behavior. The Role of Prescribers and Pharmacists in the Opportunity for Generic Drug Use and Generic Substitution," Medical Care 40, no. 8 (2002): 662-674;
17. D. Mott and E. Rothermich, "Age of Dispensed Drug Products: The Role of Insurance Type, Physician Characteristics, and Physician Practice Systems," Journal of Research in Pharmaceutical Economics 9, no. 3 (1998): 5-19;
18. and D. Mott and D. Kreling, "The Association of Insurance Type with Costs of Prescribed Drugs," Inquiry 3, no. 1 (1998): 23-25.