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

基本信息

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
项目类别：
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

项目摘要

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案 (MMA) 要求大幅降低门诊化疗药物的支付率。 MMA 的变更于 2005 年 1 月 1 日生效，将肿瘤药物供应商获得的利润限制为比制造商平均（全国）销售价格高出 6%。与此同时，医疗保险提高了化疗的费用。这项研究将建立在我们对 MMA 对患有肺癌和结直肠癌的医疗保险受益人化疗的总体影响的分析的基础上。在我们最近提交出版的研究中，我们发现医生通过向更多患有肺癌的医疗保险受益人提供化疗来应对 MMA 的付款变化（Jacobson 等，2009）。给予患者的药物类型也发生了变化。以前的高利润药物的使用不如付款减少之前那么普遍，而更昂贵的药物越来越多地受到对所有药物征收 6% 的利润的青睐，尽管是适度的。我们对结直肠癌受益人的分析正在进行中，尽管我们怀疑会发现类似的结果。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的差异。利用与 2003 年至 2006 年间诊断为肺癌和结直肠癌的受益人的医疗保险索赔相关的流行病学监测和最终结果 (SEER) 计划的数据，以及 2002 年至 2008 年这些人的所有相关索赔，我们计划扩展我们最近完成的工作：肺癌和结直肠癌正在进行的工作，以了解与 MMA 相关的治疗变化是否不成比例地集中在某些医疗保险群体中受益人而不是其他人，如果现有的差距因支付改革而扩大。拟议的研究旨在分析：目标 1) MMA 癌症药物支付率的变化如何影响结直肠癌和肺癌受益人癌症化疗治疗的差异。目标 2) MMA 支付率的变化如何影响接受化疗的患者所使用的药物类型的差异。目标 3) MMA 支付率的变化如何影响结直肠癌和肺癌受益人的生存差异我们提出的工作将是关于支付改革对差异变化影响的极少数研究之一。此外，据我们所知，这将是第一个旨在专门了解 MMA 如何对不同人口和地理群体的化疗治疗和结果产生不同影响的项目。公共健康相关性：2003 年《医疗保险现代化法案》(MMA) 要求大幅降低门诊化疗药物的支付率。在最近提交的研究中，我们发现，为了应对 MMA 的支付变化，患有肺癌的医疗保险受益人更有可能接受化疗治疗，并且以此类治疗为条件，更有可能接受昂贵的药物。拟议研究的目标是确定这些变化（如果有的话）如何影响化疗治疗和结果的差异。