The impact of Medicare part D on income-related inequality in pharmaceutical expenditure
BACKGROUND:Income-related inequality measures such as the concentration index are often used to describe the unequal distribution of health, health care access, or expenditure in a single measure. This study demonstrates the use of such measures to evaluate the distributional impact of changes in he...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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BioMed Central
2019
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| _version_ | 1826256423026163712 |
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| author | Carvalho, N Petrie, D Chen, L Salomon, JA Clarke, P |
| author_facet | Carvalho, N Petrie, D Chen, L Salomon, JA Clarke, P |
| author_sort | Carvalho, N |
| collection | OXFORD |
| description | BACKGROUND:Income-related inequality measures such as the concentration index are often used to describe the unequal distribution of health, health care access, or expenditure in a single measure. This study demonstrates the use of such measures to evaluate the distributional impact of changes in health insurance coverage. We use the example of Medicare Part D in the United States, which increased access to prescription medications for Medicare beneficiaries from 2006.
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METHODS:Using pooled cross-sectional samples from the Medical Expenditure Panel Survey for 1997-2011, we estimated income-related inequality in drug expenditures over time using the concentration and generalised concentration indices. A difference-in-differences analysis investigated the change in inequality in drug expenditures, as measured using the concentration index and generalised concentration index, between the elderly (over 65 years) and near-elderly (54-63 years) pre- and post-implementation of Medicare Part D.
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RESULTS:Medicare Part D increased public drug expenditure while out-of-pocket and private spending fell. Public drug expenditures favoured the poor during all study periods, but the degree of pro-poorness declined in the years immediately following the implementation of Part D, with the poor gaining less than the rich in both relative and absolute terms. Part D also appeared to result in a fall in the pro-richness of private insurance drug expenditure in absolute terms but have minimal distributional impact on out-of-pocket expenditure. These effects appeared to be short lived, with a return to the prevailing trends in both concentration and generalised concentration indices several years following the start of Part D.
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CONCLUSIONS:The implementation of Medicare Part D significantly reduced the degree of pro-poorness in public drug expenditure. The poor gained less of the increased public drug expenditure than the rich in both relative and absolute terms. This study demonstrates how income-related inequality measures can be used to estimate the impact of health system changes on inequalities in health expenditure and provides a guide for future evaluations. |
| first_indexed | 2024-03-06T18:02:02Z |
| format | Journal article |
| id | oxford-uuid:001b083a-3a66-4ec6-9d38-12dfc1446095 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:02:02Z |
| publishDate | 2019 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:001b083a-3a66-4ec6-9d38-12dfc14460952022-03-26T08:27:48ZThe impact of Medicare part D on income-related inequality in pharmaceutical expenditureJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:001b083a-3a66-4ec6-9d38-12dfc1446095EnglishSymplectic ElementsBioMed Central2019Carvalho, NPetrie, DChen, L Salomon, JAClarke, PBACKGROUND:Income-related inequality measures such as the concentration index are often used to describe the unequal distribution of health, health care access, or expenditure in a single measure. This study demonstrates the use of such measures to evaluate the distributional impact of changes in health insurance coverage. We use the example of Medicare Part D in the United States, which increased access to prescription medications for Medicare beneficiaries from 2006. <br><br> METHODS:Using pooled cross-sectional samples from the Medical Expenditure Panel Survey for 1997-2011, we estimated income-related inequality in drug expenditures over time using the concentration and generalised concentration indices. A difference-in-differences analysis investigated the change in inequality in drug expenditures, as measured using the concentration index and generalised concentration index, between the elderly (over 65 years) and near-elderly (54-63 years) pre- and post-implementation of Medicare Part D. <br><br> RESULTS:Medicare Part D increased public drug expenditure while out-of-pocket and private spending fell. Public drug expenditures favoured the poor during all study periods, but the degree of pro-poorness declined in the years immediately following the implementation of Part D, with the poor gaining less than the rich in both relative and absolute terms. Part D also appeared to result in a fall in the pro-richness of private insurance drug expenditure in absolute terms but have minimal distributional impact on out-of-pocket expenditure. These effects appeared to be short lived, with a return to the prevailing trends in both concentration and generalised concentration indices several years following the start of Part D. <br><br> CONCLUSIONS:The implementation of Medicare Part D significantly reduced the degree of pro-poorness in public drug expenditure. The poor gained less of the increased public drug expenditure than the rich in both relative and absolute terms. This study demonstrates how income-related inequality measures can be used to estimate the impact of health system changes on inequalities in health expenditure and provides a guide for future evaluations. |
| spellingShingle | Carvalho, N Petrie, D Chen, L Salomon, JA Clarke, P The impact of Medicare part D on income-related inequality in pharmaceutical expenditure |
| title | The impact of Medicare part D on income-related inequality in pharmaceutical expenditure |
| title_full | The impact of Medicare part D on income-related inequality in pharmaceutical expenditure |
| title_fullStr | The impact of Medicare part D on income-related inequality in pharmaceutical expenditure |
| title_full_unstemmed | The impact of Medicare part D on income-related inequality in pharmaceutical expenditure |
| title_short | The impact of Medicare part D on income-related inequality in pharmaceutical expenditure |
| title_sort | impact of medicare part d on income related inequality in pharmaceutical expenditure |
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