Are Disparities in Cancer Chemotherapy Treatment Affected by Medicare Reimburseme

癌症化疗治疗的差异是否受到医疗保险报销的影响

• 批准号: 8114179
• 负责人: Mireille Jacobson
• 金额: $ 28.33万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-20 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8114179
• 关键词: Accounting; Affect; Age; Antineoplastic Agents; Atlases; Cancer Etiology; Caring; Censuses; Cessation of life; Chemotherapy-Oncologic Procedure; Colorectal Cancer; Data; Data Set; Diagnosis; Dimensions; Education; Eligibility Determination; Ethnic Origin; Fees; Geography; Goals; Health Service Area; Healthcare; Hispanics; Household; Incidence; Income; Individual; Life; Link; Low income; Malignant Neoplasms; Malignant neoplasm of lung; Manufacturer Name; Measures; Medicaid; Medical; Medical Surveillance; Medicare; Medicare claim; Modernization; Outpatients; Patients; Pattern; Pharmaceutical Preparations; Policies; Population; Positioning Attribute; Price; Provider; Proxy; Publications; Race; Reporting; Research; Research Methodology; Rural; SEER Program; Sales; Socioeconomic Status; Source; Staging; Time; TimeLine; Transportation; Treatment outcome; United States; Update; Validation; Variant; Work; advanced disease; base; beneficiary; cancer therapy; chemotherapy; cohort; common treatment; cost; end of life; experience; federal poverty level; geographic difference; high school; member; oncology; payment; public health relevance; residence; response; rural area; urban area

DESCRIPTION (provided by applicant): The Medicare Modernization Act of 2003 (MMA) mandated substantial reductions in payment rates for outpatient chemotherapy drugs. The MMA's changes, which took effect on January 1, 2005, capped the margins providers receive on oncology drugs at 6 percent above manufacturers' average (national) sales prices. At the same time, Medicare increased the fees for chemotherapy administration. This study will build on our analysis of the overall effects of the MMA on chemotherapy treatment for Medicare beneficiaries with lung and colorectal cancer. In work we recently submitted for publication, we found that doctors responded to the MMA's payment changes by providing chemotherapy treatment to a greater share of Medicare beneficiaries with lung cancer (Jacobson et al. 2009). The type of agents administered to patients also changed. Previously high margin drugs were used less commonly than prior to the payment reduction and more expensive agents were increasingly, if modestly, favored by the 6 percent margin imposed on all drugs. Our analysis of beneficiaries with colorectal cancer is ongoing, although we suspect we will find similar results. The goal of this study is to understand how the large change in payment rates for cancer drugs has affected disparities in cancer treatment. Using data on the Surveillance Epidemiology and End Results (SEER) Program linked to Medicare claims for beneficiaries diagnosed with lung and colorectal cancer between 2003 and 2006 and all associated claims for these individuals from 2002 to 2008, we plan to extend our recently completed work on lung cancer and ongoing work on colorectal cancer to understand if the MMA-related changes in treatment are concentrated disproportionately in some groups of Medicare beneficiaries rather than others and if, as a result, existing disparities widen as a result of the payment reform. The proposed study aims to analyze: Aim 1) how the MMA's changes in payment rates for cancer drugs has affected disparities in cancer chemotherapy treatment for beneficiaries with colorectal and lung cancer. Aim 2) how the MMA's changes in payment rates has affected disparities in the type of drugs administered to those patients who receive any chemotherapy treatment. Aim 3) how the MMA's changes in payment rates has affected disparities in survival for beneficiaries with colorectal and lung cancer Our proposed work would be among the very few studies of the effects of payment reforms on changes in disparities. Moreover, it would be the first, to our knowledge, that seeks to specifically understand how the MMA differentially affected chemotherapy treatment and outcomes across demographic and geographic groups. PUBLIC HEALTH RELEVANCE: The Medicare Modernization Act of 2003 (MMA) mandated substantial reductions in payment rates for outpatient chemotherapy drugs. In work recently submitted, we find that in response the MMA's payment change, Medicare beneficiaries with lung cancer are more likely to receive chemotherapy treatment and, conditional on such treatment, are more likely to receive expensive agents. The goal of the proposed study is to determine how, if at all, these changes have affected disparities in chemotherapy treatment and outcomes.

描述（由申请人提供）：2003年《医疗保险现代化法》（MMA）要求大大降低门诊化疗药物的支付率。 MMA的变化于2005年1月1日生效，使利润率提供者对肿瘤药物的收到的限制为高于制造商平均（国家）销售价格的6％。同时，Medicare增加了化学疗法给药的费用。 这项研究将基于我们对MMA对肺部和结直肠癌医疗保险受益人化学疗法治疗的总体影响的分析。在我们最近提交出版的工作中，我们发现医生通过为MMA的支付变化做出了反应，通过为肺癌提供更大份额的Medicare受益人的化学疗法治疗（Jacobson等，2009）。给患者施用的药物的类型也发生了变化。以前，高利润药物的使用量比降低付款之前的使用量少，而且昂贵的代理商越来越多地受到对所有药物的6％的利润率的青睐。我们对结直肠癌受益人的分析正在进行中，尽管我们怀疑我们会发现类似的结果。 这项研究的目的是了解癌症药物支付率的巨大变化如何影响癌症治疗方面的差异。使用有关监测流行病学和最终结果的数据（SEER）计划，与医疗保险有关2003年至2006年间诊断为肺和结直肠癌的受益人的索赔以及2002年间对这些人的所有相关主张，我们计划从最近完成的肺癌和肺癌中的肺癌中的持续性综合性综合性综合的肺癌中，我们计划扩大我们最近完成的对肺癌的工作，以扩展我们的肺癌，并延长了一项综合性。其他人以及结果，由于付款改革而现有的差异扩大。 拟议的研究旨在分析：目标1）MMA的癌症药物支付率的变化如何影响结直肠癌和肺癌受益人的癌症化学疗法治疗方面的差异。 目标2）MMA的支付率变化如何影响接受接受任何化学疗法治疗的患者的药物类型的差异。 目标3）MMA的支付率变化如何影响结直肠癌和肺癌受益人生存的差异，我们的拟议工作将是关于付款改革对差异变化的影响的很少的研究。此外，据我们所知，这将是第一个试图特别了解MMA差异化的化学疗法治疗和人口和地理群体的结果。 公共卫生相关性：2003年《医疗保险现代化法》（MMA）要求大大降低门诊化疗药物的支付率。在最近提交的工作中，我们发现，为了响应MMA的付款变化，患有肺癌的医疗保险受益人更有可能接受化学疗法治疗，并且以这种治疗为条件，更有可能接受昂贵的药物。拟议的研究的目的是确定这些变化如何影响化学疗法治疗和结果的差异。