title: Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage.
abstract: BACKGROUND
  Implementation of Medicare Part D was followed by increased use of prescription medications, reduced out-of-pocket costs, and improved medication adherence. Its effects on nondrug medical spending remain unclear.
  
  
  OBJECTIVE
  To assess differential changes in nondrug medical spending following the implementation of Part D for traditional Medicare beneficiaries with limited prior drug coverage.
  
  
  METHODS
  Nationally representative longitudinal survey data and linked Medicare claims from 2004-2007 were used to compare nondrug medical spending before and after the implementation of Part D by self-reported generosity of prescription drug coverage before 2006. Participants included 6001 elderly Medicare beneficiaries from the Health and Retirement Study, including 2538 with generous and 3463 with limited drug coverage before 2006. Comparisons were adjusted for sociodemographic and health characteristics and checked for residual confounding by conducting similar comparisons for a control cohort from 2002-2005.
  
  
  METHODS
  Nondrug medical spending assessed from claims, in total and by type of service (inpatient and skilled nursing facility vs physician services).
  
  
  RESULTS
  Total nondrug medical spending was differentially reduced after January 1, 2006, for beneficiaries with limited prior drug coverage (-$306/quarter [95% confidence interval {CI}, -$586 to -$51]; P = .02), relative to beneficiaries with generous prior drug coverage. This differential reduction was explained mostly by differential changes in spending on inpatient and skilled nursing facility care (-$204/quarter [95% CI, -$447 to $2]; P = .05). Differential reductions in spending on physician services (-$67/quarter [95% CI, -$134 to -$5]; P = .03) were not associated with differential changes in outpatient visits (-0.06 visits/quarter [95% CI, -0.21 to 0.08]; P = .37), suggesting reduced spending on inpatient physician services for beneficiaries with limited prior drug coverage. In contrast, nondrug medical spending in the control cohort did not differentially change after January 1, 2004, for beneficiaries with limited prior drug coverage in 2002 ($14/quarter [95% CI, -$338 to $324]; P = .93), relative to beneficiaries with generous prior coverage.
  
  
  CONCLUSIONS
  Implementation of Part D was associated with significant differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA. mcwilliams@hcp.med.harvard.edu
authors.forename: J Michael
authors.initials: JM
authors.lastname: McWilliams
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003363:Cost Control; D003365:Costs and Cost Analysis; D003625:Data Collection; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008137:Longitudinal Studies; D008297:Male; D054524:Medicare Part D / Q000191:economics*; D005791:Patient Care / Q000191:economics*; D010820:Physicians; D012866:Skilled Nursing Facilities / Q000191:economics*; D014481:United States