Effects of Medicaid Prescription Drug Copayment Policy on Health Outcomes and Expenditures in a Dually Enrolled Dialysis Population.

摘要

Instituting copayments for Medicaid prescription drugs has been a cost-containment strategy implemented by states, and studies have shown that beneficiary cost sharing has led to a decrease in prescription drug utilization. What is unclear is the effect of copayments on utilization and expenditures for other medical services, particularly for patients with chronic illness. The sample included 13,756 dialysis patients from 30 states who were continuously dually enrolled in fee-for-service Medicare and Medicaid during 1995. Contrary to expectations, regression results showed that patients living in states with sliding scale drug copayments had fewer hospital days and lower expenditures than patients who did not face drug copayments. Flat rate copayments were negatively associated with hospital use. Copayment policy was not significantly related to ER visits or mortality. Illness severity measures, demographic characteristics, and other Medicaid program characteristics were strong predictors of resource utilization and medical expenditures.