Medicare Medicare Part D Pharmaceuticals

Did Medicare Part D reduce emergency room visits?

In 2006, the Medicare program was expanded to include prescription drug coverage through the Part D program. Previous studies have found that Medicare Part D improved prescription drug coverage rates among seniors (Levy and Weir,2010), increased medication utilization (Duggan and Morton, 2010), decreased out-of-pocket spending (Engelhardt and Gruber, 2011; Ketcham and Simon, 2008), and reduced medication non-adherence (Madden et al., 2008).  Other studies have found that Medicare Part D decreases hospiatlization rates (Afendulis et al., 2011; Kaestner et al.,
2014).  However, was Medicare Part D able to reduce ER admissions?

A paper by Ayyagari, Shane and Wehby (2016) attempts to answer this question using data from Medical Expenditure Panel Survey (MEPS) between 2000 and 2012.  The authors examine patients aged 60 to 70 in each year of the survey.  The authors use a difference in difference method to examine whether the difference between ED visit rates among patients 65-70 shrank relative to ED visits among patients aged 60-64 in the years after Part D was enacted.  They specifically look at hospitalizations for (1) diagnosis or treatment; (2) emergency (e.g., accident or injury); (3) psychotherapy or mental health counseling; (4) follow-up or postoperative visit; and (5) immunizations or shots.  They subdivide the analysis by accident/injury related ED visits–where one would hypothesize that there would be little change in ED visits due to Medicare Part D– and the four other types of ED visits–which could be reduced by improved access to pharmaceuticals.

The authors find that:

Consistent with the notion that prescription drug coverage may help individuals better manage chronic health conditions, we find significant declines in the number of ED visits for non-emergency reasons after the implementation of Medicare Part D. At the same time, we do not find any significant changes in ED visits of an emergency nature, suggesting that the decreased utilization that we observe is not being driven by reduced access to ED care…Our analysis suggests that any increases in the cost of covering prescription drugs may be partially offset by reduced ED use.


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