Financial disparities in prescription drug use between elderly and nonelderly Americans

Health Affairs

Volumn 22, Issue 5, 2003, Pages 210-221

  Xu, K Tom ^a  

^a TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ADULT; AGE; AGED; ARTICLE; COMPARATIVE STUDY; COST; CROSS-SECTIONAL STUDY; DRUG UTILIZATION; ECONOMICS; EPIDEMIOLOGY; FINANCIAL MANAGEMENT; HEALTH CARE COST; HUMAN; MEDICARE; MIDDLE AGED; POVERTY; PRESCRIPTION; SOCIOECONOMICS; STATISTICS; UNITED STATES;

ADOLESCENT; ADULT; AGE FACTORS; AGED; COST SHARING; CROSS-SECTIONAL STUDIES; DRUG UTILIZATION; FINANCING, PERSONAL; HEALTH CARE SURVEYS; HEALTH EXPENDITURES; HUMANS; MEDICARE; MIDDLE AGED; POVERTY; PRESCRIPTIONS, DRUG; SOCIOECONOMIC FACTORS; UNITED STATES;

EID: 1542785787     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.22.5.210     Document Type: Article

References (18)

1. See SW. Letsch, "National Health Care Spending in 1991," Health Affairs (Spring 1993): 94-110;
2. S.H. Long, "Prescription Drugs and the Elderly: Issues and Options," Health Affairs (Spring II 1994): 157-174;
3. and J.A. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries with and without Drug Coverage," Health Affairs (Mar/Apr 2001): 74-85.
4. Poisal and Murray, "Growing Differences."
5. 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 (15 June 2003).
6. Long, "Prescription Drugs and the Elderly."
7. M.K. Anglin and J.C. White, "Poverty, Health Care, and Problems of Prescription Medication: A Case Study," Substance Use and Misuse (14 December 1999): 2073-2093;
8. T.J. Reutzel, "Pharmacists' Estimates of How Often Patients Cannot Afford Their Prescriptions and What Pharmacists Can Do to Help," Journal of Social and Administrative Pharmacy 10, no. 3 (1993): 180-182;
9. M.D. Schoen et al., "Impact of the Cost of Prescription Drugs on Clinical Outcomes in Indigent Patients with Heart Disease," Pharmacotherapy (12 December 2001): 1455-1463;
10. and W.J. Strickland and C.M. Hanson, "Coping with the Cost of Prescription Drugs," Journal of Health Care for the Poor and Underserved 7, no. 1 (1996): 50-62.
11. M. McClellan, I.D. Spatz, and S. Carney, "Designing a Medicare Prescription Drug Benefit: Issues, Obstacles, and Opportunities," Health Affairs (Mar/Apr 2000): 26-41.
12. H.A. Huskamp et al., "The Medicare Prescription Drug Benefit: How Will the Game Be Played?" Health Affairs (Mar/Apr 2000): 8-23.
13. S. Christensen and J. Wagner, "The Costs of a Medicare Prescription Drug Benefit," Health Affairs (Mar/Apr 2000): 212-218.
14. Agency for Healthcare Research and Quality, "Medical Expenditure Panel Survey," www.ahrq.gov/data/mepsix.htm (15 June 2003).
15. More details on data collection processes, survey design, and methodology are available in J.P. Vistnes and A.C. Monheit, Health Insurance Status of the U.S. Civilian Noninstitutionalized Population, 1996, MEPS Research Findings no. 1, Pub. no. 97-0030 (Rockville, Md.: AHRQ, 1997).
16. For a detailed listing, see AHRQ, "MEPS HC-027: 1998 Medical Conditions," December 2001, www.meps.ahrq.gov/Pubdoc/HC027/h27doc.pdf (15 June 2003).
17. The counts of prescribed medicine use were based on household reports, and the details of medication, spending, and payment data were obtained from pharmacies. Consequently, prescription drug use may be underreported. In addition, over-the-counter (OTC) drug use was not included in MEPS. These two factors could explain the differences in the findings regarding drug spending between the current study and data from the 1998 Medicare Current Beneficiary Survey (MCBS). However, if the probabilities of underreporting are similar between the elderly and nonelderly adult populations, the calculated elderly-nonelderly differences might not have been greatly influenced by the underreporting bias.
18. The use of different specifications of health care need could alter the magnitude of the estimated elderly-nonelderly disparities. As suggested by a study of gender differences, the more detailed the health measure, the smaller the gender difference. K.T. Xu and T.F. Borders, "Gender, Health, and Physician Visits among Adults in the United States," American Journal of Public Health (July 2003): 1076-1079. In the current study, an alternative specification of using 258 dummies for the Clinical Classification Codes was also tested. Similar to the conclusions drawn by Xu and Borders, elderly-nonelderly differences were smaller but still significant at alpha = .01. In another specification, where health is measured by only overall physical and mental health, elderly-nonelderly differences were greater. To keep the model parsimonious and to include somewhat detailed health conditions, we used the specification with intermediate complexity (overall health and selected priority conditions), following the conclusion from the Xu and Borders study.