• Part D and utilization/outcomes

    In a “Reading list” last month, I cited Kaestner’s and Khan’s recent NBER paper Medicare Part D and its Effect on the Use of Prescription Drugs, Use of Other Health Care Services and Health of the Elderly. I didn’t read that paper myself yet. Today Jason Shafrin summarizes it while briefly describing the findings of other, related work. It’s a short post so I’m not going to provide a condensed version. Just follow the links.

    Jason concludes,

    In fact, the authors note the following: “If anything, estimates suggested that gaining prescription drug insurance was associated with worsening health.” Could this be because some physicians overprescribe drugs which could actually worsen outcomes? Is functional status and self-reported health sufficiently precise to capture the benefit of these drugs? Are the benefits of pharmaceuticals generally confined to short-run benefits?

    Another possibility is that it isn’t the increased drug utilization that is producing this effect, it’s the decrease in outpatient utilization, which the authors also find (or did they control for that in the outcome model?). Suffice it to say, this begs quite a few questions similar to these, does it not?

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    • Potentially it is that the drugs are used as a cheaper or easier alternative to another more intrusive or costly procedure. Rather than solving the problem, the drugs merely attack symptoms. Also, medical errors such as improper dosage, adverse drug interactions and failure to account for another complicating factor, such as using a drug with an excessive toxicity level for a patient with renal issues, could be playing a major role here.