Response to Medicare Reimbursement Policy Change by Minority and All ESRD Patient

少数族裔和所有 ESRD 患者对医疗保险报销政策变更的回应

• 批准号: 7496311
• 负责人: C. DANIEL MULLINS
• 金额: $ 22.72万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7496311
• 关键词: Affect; African American; Age; Amendment; Belief; Binding; Budgets; Caring; Characteristics; Clinical; Collaborations; Congresses; Diagnosis; Dialysis procedure; Disabled Persons; Disadvantaged; Disease; Drug Prescriptions; Drug usage; Economics; Eligibility Determination; End stage renal failure; Equilibrium; Ethnic Origin; Funding; Future; Goals; Health; Health Policy; Health Services Accessibility; Healthcare; Healthy People 2010; Hispanics; Hospitals; Immunosuppressive Agents; Individual; Insurance; Insurance Coverage; Kidney; Kidney Diseases; Kidney Transplantation; Knowledge; Laws; Learning; Low income; Medical; Medicare; Minority; Modeling; Not Hispanic or Latino; Numbers; Organ; Organ Transplantation; Other Minority; Outcome; Patient Outcomes Assessments; Patient Preferences; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physical Dialysis; Placement; Policies; Policy Maker; Population; Prevalence; Prevention; Provider; Public Health; Public Policy; Race; Rate; Relative (related person); Reporting; Research; Social Security; Staging; Standards of Weights and Measures; Testing; Time; Transplant Recipients; Transplantation; United States; Waiting Lists; base; beneficiary; disability; experience; frontier; graft failure; health disparity; improved; programs; racial and ethnic; racial and ethnic disparities; response; socioeconomics; wasting

DESCRIPTION (provided by applicant): African Americans and Hispanics are disproportionately impacted by end-stage renal disease (ESRD) based upon disease prevalence, access to transplantation among diagnosed ESRD patients, and health outcomes. The Social Security Amendments of 1972 entitled almost all patients with ESRD in the United States to Medicare-funded renal transplantation, but limited coverage of post-transplant care to 1 year. Over time, post-transplant coverage was extended to 3 years and eventually in December of 2000, the Beneficiary Improvements and Protection Act (BIPA 2000) provided an opportunity for extended post-transplant coverage for Medicare beneficiaries whose eligibility was based on age or non-ESRD disability. Lack of supplementary coverage for the expensive anti-rejection drugs that are used for post-transplant care is higher among minorities, which partially explains why African Americans and other minorities historically have had lower rates of transplantation than non-Hispanic whites. A difference-in- difference model will be developed based upon recent USRDS standard analysis files (SAF) to compare two sets of Medicare eligible: the first, Seniors (Age >= 65) and/or non-ESRD disabled, who are affected by the changes in the Medicare Law, and the second, Non-seniors (Age < 65) who only have ESRD, and are unaffected by the changes in the Medicare Law. Since BIPA 2000 was intended to reduce the patient's financial burden associated with post-transplant immunosuppressant drugs, passage of this law should disproportionately (positively) impact the rates of placement on the wait list for renal transplant and actual renal transplantation for the financially disadvantaged population, many of whom are minorities. This research will inform future health policy makers regarding the Congress' ability to improve the public health of our nation's growing ESRD population and reduce racial and ethnic health disparities. PUBLIC HEALTH RELEVANCE: The research proposed in this application will explore the response to the passage of the Beneficiary Improvements and Protection Act (BIPA 2000) on the overall rate of renal transplantation, and the rate of placement on the renal transplantation waitlist. BIPA 2000 provided an opportunity for extended Medicare coverage for post-transplantation immunosuppressant drugs; if patients with ESRD responded to this, then passage of BIPA 2000 should positively affect the rates of transplantation for all patients with ESRD but particularly those sub-populations who are financially disadvantaged. Since, unfortunately, minorities are disproportionately among this financially disadvantaged group, we propose to test whether this policy change positively affects minorities and contributes towards the reduction in racial and ethnic disparities in the transplantation rates.

描述（由申请人提供）：根据疾病患病率、确诊的 ESRD 患者接受移植的情况以及健康结果，非洲裔美国人和西班牙裔人受到终末期肾病 (ESRD) 的影响尤为严重。 1972 年的社会保障修正案赋予美国几乎所有 ESRD 患者医疗保险资助的肾移植权利，但移植后护理的覆盖范围仅限于 1 年。随着时间的推移，移植后承保范围延长至 3 年，最终在 2000 年 12 月，受益人改进和保护法案 (BIPA 2000) 为根据年龄或非医疗保险受益人的资格延长移植后承保范围提供了机会。 ESRD 残疾。在少数族裔中，用于移植后护理的昂贵抗排斥药物缺乏补充保险的情况较高，这部分解释了为什么非裔美国人和其他少数族裔历史上的移植率低于非西班牙裔白人。将根据最近的 USRDS 标准分析文件 (SAF) 开发一个双重差异模型，以比较两组符合医疗保险资格的人：第一组是老年人（年龄 >= 65 岁）和/或非 ESRD 残疾人，他们受到以下因素的影响：二是仅患有终末期肾病（ESRD）的非老年人（年龄<65岁），不受医疗保险法变更的影响。由于 BIPA 2000 旨在减轻患者与移植后免疫抑制剂相关的经济负担，该法律的通过应不成比例地（积极）影响经济困难人群的肾移植等候名单上的比率和实际肾移植的比率，其中许多人是少数民族。这项研究将为未来的卫生政策制定者提供有关国会改善我国不断增长的终末期肾病人口的公共卫生并减少种族和民族健康差异的能力的信息。公共健康相关性：本申请中提出的研究将探讨受益人改进和保护法案 (BIPA 2000) 的通过对肾移植总体率以及肾移植候补名单上的安置率的反应。 BIPA 2000 为扩大移植后免疫抑制药物的医疗保险覆盖范围提供了机会；如果 ESRD 患者对此做出反应，那么 BIPA 2000 的通过应该会对所有 ESRD 患者的移植率产生积极影响，特别是那些经济困难的亚人群。不幸的是，由于少数族裔在这个经济弱势群体中所占比例过高，因此我们建议测试这一政策变化是否对少数族裔产生积极影响，并有助于减少移植率方面的种族和民族差异。