This study examines the relationship between two state Medicaid home and community-based services (HCBS) policies - number of beneficiaries (Participation) and use per beneficiary (Intensity) - and individual health expenditures. Data include the 2008-2013 Medicare Current Beneficiary Survey and state-level Medicaid HCBS indicators. Two-part generalized linear models are estimated for health expenditures by payer and dual-eligibility status. The likelihood and level of Medicare expenditures are significantly lower in states in the top quartile of Participation and Intensity. Findings suggest that state Medicaid HCBS policies may impact health expenditures, with potential spillover effects on Medicare spending.
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http://dx.doi.org/10.1080/08959420.2021.1938484 | DOI Listing |
JAMA Netw Open
January 2025
Clinical Product Development, Waymark, San Francisco, California.
Importance: Rising prescription medication costs under Medicaid have led to increased procedural prescription denials by health plans. The effect of unresolved denials on chronic condition exacerbation and subsequent acute care utilization remains unclear.
Objective: To examine whether procedural prescription denials are associated with increased net spending through downstream acute care utilization among Medicaid patients not obtaining prescribed medication following a denial.
BMC Public Health
January 2025
Centre for Healthcare Management, Administrative Staff College of India (ASCI), Hyderabad, India.
Background: Substantial out-of-pocket (OOP) expenditures push a large portion of the population below the poverty line, especially those residing in rural areas having low incomes. Individuals from economically disadvantaged states in India incur higher healthcare costs for hospitalization in public health centers than do those from more developed states. Economically poorer households in states such as Bihar and Odisha face significantly higher OOP expenditures for hospitalization in public health centers than do those in economically developed states such as Tamil Nadu.
View Article and Find Full Text PDFValue Health
January 2025
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
Objectives: We investigated how the Inflation Reduction Act (IRA) Medicare Part D benefit redesign may reduce out-of-pocket (OOP) drug expenditures for Medicare beneficiaries with dementia. Methods Design Utilizing data from the Health and Retirement Study (HRS) linked with Medicare claims, we simulated post-redesign OOP drug spending by applying the 2025 prescription drug cost-sharing rules to each beneficiary's pre-redesign Part D medication utilization data for 2016, adjusting for inflation. Participants Our study population comprised HRS respondents aged 65 and older in 2016, enrolled in Medicare fee-for-service, with at least one Part D drug claim in 2016, and diagnosed with dementia between 2000 and 2016 (n=1,677).
View Article and Find Full Text PDFEpidemiol Serv Saude
January 2025
Universidade de Brasília, Faculdade de Ceilândia, Brasília, DF, Brasil.
Objective: To investigate the evolution of prevalence of catastrophic health expenditure in the Brazilian Federal District at three different times (2003, 2009 and 2018), as well, to identify the composition of outof- pocket expenditure in the respective years.
Method: Time series study, using descriptive data from the Family Budget Survey. Prevalence was stratified by consumption quintiles.
Front Public Health
January 2025
Rajavithi Hospital, College of Medicine, Ministry of Public Health, Rangsit University, Bangkok, Thailand.
Objective: This study aimed to assess the financial impact of different adoption rates of insulin glargine (IGlar) treatment compared to isophane protamine (neutral protamine hagedorn [NPH]) insulin treatment for patients with type-2 diabetes (T2D) and severe hypoglycemia in Thailand from the payer's perspective.
Methods: The budget impact analysis (BIA) model over a period of 5 years was used to estimate the net budget impact (NBI) of IGlar treatment by comparing the total budget expenditures under two scenarios: scenario 1 involved only NPH insulin and scenario 2 included the introduction of IGlar. The total budget included either the cost of insulin or a combination of the costs of insulin and the expense related to severe hypoglycemia.
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