Health Affairs: Medicare Doesn't Work As Well For Younger, Disabled Beneficiaries As It Does For Older Enrollees - This paper examines "how well Medicare works for [the 8 million] nonelderly disabled beneficiaries compared to the elderly, based on findings from a nationally representative survey of noninstitutionalized Medicare beneficiaries conducted in 2008 by the Kaiser Family Foundation."
"Compared to less than 20 percent of the elderly, roughly half of nonelderly disabled Medicare beneficiaries reported problems paying for health care services, and put off or did not get care because of cost concerns. For both nonelderly and elderly beneficiaries, cost-related barriers were most frequently cited for dental services, followed by prescription drugs, over-the-counter medications, and visits to doctors. ... Moreover, among those who reported delays or not getting services due to costs, a larger share of nonelderly beneficiaries reported experiencing negative consequences as a result," such as "the worsening of existing medical problems, physical pain, and stress or anxiety." The article also describes differences between the beneficiaries in health care use, access to prescription drugs through Medicare Part D, and experiences with supplemental coverage (Cubanski and Neuman, 8/12).
Archives of Internal Medicine: Impact Of Medicare Part D On Seniors' Out-Of-Pocket Expenditures On Medications - "The implementation of Medicare Part D was driven by concerns that cost sharing for prescription medications was placing an increasing financial burden on seniors and by documented evidence that cost sharing has negative effects on adherence to therapy and health care utilization," according to this study based on Medical Expenditure Panel Survey (MEPS) data. "Mean out-of-pocket annual expenditures on all medications decreased by 32% … from $1011 to $691, in the year after Medicare Part D was implemented compared with the year before in all Medicare beneficiaries participating in the MEPS."
"Although the implication of these findings is that Medicare Part D has achieved some of its intended effect of reducing Medicare beneficiaries' out-of-pocket expenditures on medications, a question remains about whether the financial gain derived by beneficiaries is sufficient given the high public cost of the program," the authors write. "This is highlighted by the considerable gap between the reduction in out-of-pocket expenditures experienced by all Medicare beneficiaries in this study and the per capita investment in this program in 2006 ($320 vs $1742)" (Millett et al., 8/9).
Archives of Internal Medicine: Ambulatory Antibiotic Use And Prescription Drug Coverage In Older Adults - Researchers analyzed data from a large Medicare Advantage plan two years before the 2006 implementation of Medicare Part D and two years after it went into effect, specifically focusing on the rates of antibiotic use among those with pneumonia and other acute respiratory tract infections (ARIs).
"In summary, use of antibiotics increased as individuals gained better drug coverage, especially for broad spectrum, newer, and more expensive antibiotics. We found increases in the likelihood of antibiotic treatment for pneumonia and other ARIs," the authors report. "These increases took place against a backdrop of national declines in antibiotic use overall. Our study suggests that reimbursement may play a role in addressing the substantial role of inappropriate antibiotic prescribing and use" (Zhang, Lee and Donohue, 8/9).
Journal of the American Medical Association: Trends And Characteristics Of US Emergency Department Visits, 1997-2007 - Using "the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual, national probability sample survey of hospital [emergency departments] conducted by the National Center for Health Statistics," this study found that "between 1997 and 2007, the total annual visits to US EDs increased by 23%—corresponding to an estimated 21 million additional ED visits nationwide. This is roughly twice the rate of growth of the US population over the same time period. Persons insured by Medicaid, particularly nonelderly adults, accounted for a large proportion of this increase. ... One possible explanation for these trends is that adults with Medicaid are experiencing increasing difficulties in accessing primary care" (Tang et al., 8/11).
Kaiser Family Foundation: Optimizing Medicaid Enrollment: Spotlight On Technology - This spotlight paper (.pdf) - the first in a series on the technology that states are using to develop innovative ways to increase and simplify Medicaid enrollment - profiles Louisiana's "Express lane eligibility" (ELE), a program "that allows state Medicaid and CHIP agencies to rely on eligibility findings from other public programs such as SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps) or Head Start, and/or tax return data, to identify, enroll, and recertify children ..."
"In February 2010, the month after ELE was launched, Medicaid enrolled more than 10,000 children in one stroke using the new process ... Despite a 12% reduction in the Medicaid workforce in the last two years, neither the volume nor the quality of eligibility processing has declined. ... States that harness the potential of ELE to enroll children in Medicaid today are likely to realize not only important gains in children's coverage, but also system efficiencies that can help states prepare for the new pressures on Medicaid eligibility and enrollment processes when the Medicaid expansion under health reform is implemented in 2014," the authors write (8/4).
Kaiser Family Foundation: Explaining Health Reform: Benefits And Cost-Sharing For Adult Medicaid Beneficiaries - "Under health reform, Medicaid eligibility will be expanded to reach nearly everyone under age 65 with income below 133 percent of the federal poverty level. As a result, millions of uninsured adults, including many with very low income and significant health needs, will become eligible for the program. This brief provides details of the benefit and cost-sharing rules that will govern the coverage available to these newly eligible adults Medicaid beneficiaries, and it identifies key considerations for state policymakers making Medicaid benefit design choices" (Guyer and Paradise, 8/9).