Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States

Abstract

This study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004–2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005–2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006–2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults’ overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.

Keywords

Medicare Part D health outcomes prescription drugs self-rated health

Get full access to this article

View all access options for this article.

References

Donohue

Zhang

Lave

et al.

The medicare drug benefit (Part D) and treatment of heart failure in older adults. Am Heart J 2010; 160(1): 159–165.

Lichtenberg

Sun

. The impact of medicare Part D on prescription drug use by the elderly. Health Aff 2007; 26(6): 1735–1744.

Madden

Graves

Ross-Degnan

Briesacher

Soumerai

. Cost-related medication nonadherence after implementation of Medicare Part D, 2006–2007. JAMA 2009; 302(16): 1755.

Safran

Strollo

Guterman

Rogers

Neuman

. Prescription coverage, use and spending before and after Part D implementation: a national longitudinal panel study. J Gen Intern Med 2010; 25(1): 10–17.

Levy

Weir

. Take-up of medicare Part D: results from the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2010; 65(4): 492–501.

Neuman

Strollo

Guterman

et al.

Medicare prescription drug benefit progress report: findings from a 2006 national survey of seniors. Health Aff 2007; 26(5): w630–w643.

Schneeweiss

Patrick

Pedan

et al.

The effect of Medicare Part D coverage on drug use and cost sharing among seniors without prior drug benefits. Health Aff 2009; 28(2): w305–w316.

Andersen

. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995; 36(1): 1–10.

Atchison

Andersen

. Demonstrating successful aging using the International Collaborative Study for oral health outcomes. J Public Health Dent 2000; 60(4): 282–288.

10.

Baker

. Applying Andersen’s behavioural model to oral health: what are the contextual factors shaping perceived oral health outcomes? Community Dent Oral Epidemiol. 2009. 37(6): 485–494.

11.

Gunasekara

Carter

Blakely

. Comparing self-rated health and self-assessed change in health in a longitudinal survey: which is more valid? Soc Sci Med 2012; 74(7): 1117–1124.

12.

Han

Phillips

Ferrucci

et al.

Change in self-rated health and mortality among community-dwelling disabled older women. Gerontologist 2005; 45(2): 216–221.

13.

Amirkhanyan

Wolf

. Parent care and the stress process: findings from panel data. J Gerontol B Psychol Sci Soc Sci 2006; 61(5): S248–S255.

14.

Baumann

Meyers

Le Bihan

Houssemand

. Mental health (GHQ12; CES-D) and attitudes towards the value of work among inmates of a semi-open prison and the long-term unemployed in Luxembourg. BMC Public Health 2008; 8(1): 214.

15.

Padgett

Struening

Andrews

. Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Med Care 1990; 28(9): 805–821.

16.

Zivin

Ratliff

Heisler

Langa

Piette

. Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. Value Health 2010; 13(4): 338–345.

17.

Tian

Robinson

Sturm

. Labor market, financial, insurance and disability outcomes among near elderly Americans with depression and pain. J Ment Health Policy Econ 2005; 8(4): 219.

18.

Charlson

Pompei

Ales

MacKenzie

. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373–383.

19.

Athey S, Imbens GW. Identification and inference in nonlinear difference-in-differences models. Natioanl Bureaue Economic Research technical working paper 280. http://www.nber.org/papers/t0280.pdf. Published September 2002. Accessed April 12, 2015.

20.

Abadie

. Semiparametric difference-in-differences estimators. Rev Econ 2005; 72(1): 1–19.

21.

Hoadley J, Corlette S, Summer L, Monahan C. Launching the Medicare Part D Program: Lessons for the New Health Insurance Marketplaces. Georgetown: University Health Policy Institute. http://www.rwjf.org/en/library/research/2013/06/launching-the-medicare-part-d-program–lessons-for-the-new-healt.html. Published June 2013. Accessed April 11, 2015.

22.

Katon

. Roy-Byme

. Waltham, MA: UpToDate. http://uptodate.com. Accessed April 11, 2015 .

23.

Khan

Kaestner

Lin

. Effect of prescription drug coverage on health of the elderly. Health Serv Res 2008; 43(5p1): 1576–1597.

24.

Boult

Kane

Louis

Boult

McCaffrey

. Chronic conditions that lead to functional limitation in the elderly. J Gerontol 1994; 49(1): M28–M36.

25.

Dunlop

Manheim

Sohn

M-W

Liu

Chang

. Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions. Arch Phys Med Rehabil 2002; 83(7): 964–971.

26.

Naci

Soumerai

Ross-Degnan

et al.

Medication affordability gains following Medicare Part D are eroding among elderly with multiple chronic conditions. Health Aff 2014; 33(8): 1435–1443.

27.

Covinsky

Lindquist

Dunlop

Yelin

. Pain, functional limitations, and aging. J Am Geriatr Soc 2009; 57(9): 1556–1561.

28.

Soumerai

Pierre-Jacques

Zhang

et al.

Cost-related medication nonadherence among elderly and disabled medicare beneficiaries: a national survey 1 year before the medicare drug benefit. Arch Intern Med 2006; 166(17): 1829–1835.