I reckon there would be less hospital visits due to less drug related
side effects :)
R
David More wrote:
_http://online.wsj.com/article/SB114913021252768372.html?mod=djemHL_
/*Medicare Drug-Cap Savings May Be Offset by Hospital Visits*/
*By JOHN HECHINGER
June 1, 2006; Page A4*
Capping Medicare drug benefits results in more patient visits to
emergency rooms and hospitals, offsetting savings from lower spending
on prescription medications, researchers say.
The study, published Thursday in the New England Journal of Medicine,
gives ammunition to critics of the new Medicare Part D
prescription-drug benefit, which includes payment restrictions.
Researchers at health-maintenance organization Kaiser Permanente in
Oakland, Calif.; the University of California, San Francisco; and
Harvard University examined the cost and clinical outcomes of 199,179
Kaiser beneficiaries in Northern California who were enrolled in a
program called Medicare+ Choice in 2003.
Under that program, annual drug benefits were capped at $1,000. The
study compared 157,275 Kaiser beneficiaries with caps to 41,904 who
had unlimited benefits because of supplemental coverage from their
employers.
The study, which received funding from federal agencies and the Alfred
P. Sloan Foundation, found that a cap on drug benefits lowered
pharmacy costs by 31%. But total medical costs, including drugs, were
roughly the same.
Researchers said that was largely because patients with drug caps had
a 9% higher rate of emergency-room visits, a 13% higher rate of
nonelective hospitalizations and a 22% higher death rate.
The study found subscribers with capped drug costs were less likely to
take drugs to lower blood pressure and cholesterol and to control
diabetes -- chronic conditions for which medication can offer
cost-effective drugs to prevent costly health problems later.
For example, the study found, 14.6% of those enrolled in plans without
caps failed to take their blood-pressure medication as prescribed by
their doctor, while 18.1% neglected to do so in plans with restrictions.
Researchers noted that the cap in the older Medicare plan differs from
the terms of Medicare Part D prescription drug benefit. The benefit
took effect Jan. 1, and more than 37 million senior citizens enrolled
in the plan by the initial May deadline. Under the standard Part D
plan, those who enroll pay a $250 deductible, after which they pay 25%
of the next $2,000 in costs, or $500. Then, in what critics have
called the "doughnut hole," seniors must pay 100% of drug costs for
the next $2,850. After hitting $3,600 out of pocket, they pay 5% of
drug costs above that level. Various private plans can offer richer
coverage with different terms for monthly premiums that now range from
less than $2 to about $40.
Kenneth E. Thorpe, a professor of health policy at Emory University,
who wrote an editorial about the study in the journal, said the
research shows cost saving through coverage caps is especially
wrongheaded for treating chronic diseases. In terms of Medicare Part
D, "we may very well be penny-wise and pound-foolish here," he said in
an interview.
But Peter Ashkenaz, a Medicare spokesman, said Part D doesn't
completely cut off coverage after $1,000 and is a vast improvement for
most seniors, who previously had "no coverage whatsoever" for
prescription drugs under the standard Medicare plan.
----
Dr David G More MB, PhD, FACHI
Phone +61-2-9438-2851 Fax +61-2-9906-7038
Skype Username : davidgmore
E-mail: [EMAIL PROTECTED]
HealthIT Blog - www.aushealthit.blogspot.com
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