Research roundup: Health disparities; Prescription drug abuse in Medicare Part D; Medicaid's role for HIV patients

Oct 7 2011

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Health Affairs: Achieving Equity In Health -- This policy brief examines the outlining factors that cause disparities in the health care system and focuses on the October issue of the journal, which is devoted to research on the subject. According to the brief, "disparities are costly. Among African Americans and Hispanics, the cost burden of three preventable conditions--high blood pressure, diabetes, and stroke--was about $23.9 billion in 2009." The sources of these disparities are interrelated and include economic factors, education, geography, environment and stress. Some of the recommendations made by experts, according to the brief, include, "improvements in quality of care across the board in the US health care system, with particular attention to places where minority patients are likely to recieve most of their care" (Bahls, 10/6).

Government Accountability Office: Medicare Part D: Instances Of Questionable Access To Prescription Drugs -- This report looks at fraud and abuse within the Medicare Part D prescription drug program and found 170,000 beneficiaries "received prescriptions from five or more medical practitioners for the 12 classes of frequently abused controlled substances and 2 classes of frequently abused noncontrolled substances" in 2008. The researchers also determined that most of these beneficiaries "were eligible for Medicare Part D benefits based on a disability." The federal government requires plans providing Part D coverage to review drug use to find "inappropriate or unnecessary medication use and provide education, such as alert letters, to the prescribers involved," the report notes. However, "federal law does not authorize Part D plans to restrict the access of these individuals, leaving little recourse for preventing known doctor shoppers from obtaining hydrocodone, oxycodone, and other highly abused drugs." The researchers recommended that federal officials evaluate the program "and consider additional steps, such as a restricted recipient program for Medicare Part D that would limit identified doctor shoppers to one prescriber, one pharmacy, or both for receiving prescriptions" (10/4).

Kaiser Family Foundation: Medicaid And HIV: A National Analysis -- This report assesses Medicaid's role in providing coverage to people with HIV. "Although Medicaid enrollees with HIV represent just a small fraction of the overall Medicaid population, they account for a significant share of people with HIV in regular care," the author writes. The research examines enrollment of HIV patients and health care spending. It finds Medicaid enrollees with HIV "have higher costs, even when compared to other high-cost enrollees groups such as the elderly and disabled, reflecting their care needs and the high cost of HIV care," according to the report. A large part of that is attributed to spending for prescription drugs. These findings act as a baseline "for monitoring the impact of health care reform, which is expected to significantly change this picture in 2014. At that time, many more low income people with HIV will be able to qualify for Medicaid without having to be disabled, which has in the past presented a barrier to their access" (Kates, 9/30).

Urban Institute/Robert Wood Johnson Foundation: Refocusing Responsibility For Dual Eligibles: Why Medicare Should Take The Lead -- This report looks at the issues facing dual eligibles -- the 9 million people who are covered by both Medicare, which is paid for by the federal government, and Medicaid, whose cost are shared by the federal and state governments. The authors suggest that Medicare should take responsiblity for dual eligibles to more efficiently provide care. "But states pay for only 20 percent of spending on dual eligibles, very little of which goes toward acute care, where savings and quality improvement are most readily achievable. These services are Medicare's responsibility, and the savings are Medicare's to pursue," the authors write. "Allowing state initiatives to absolve Medicare of responsibility for improving the quality and efficiency of the care it finances simply does not make sense (Feder, et. al., October 2011).

Archives Of Internal Medicine: 'Top 5' Lists Top $5 Billion -- This research letter evaluates unnecessary spending within pediatrics, internal medicine and family medicine. Researchers used federal health care data to examine patient visits to primary care doctors to see how often they engaged in the top 5 overused clinical activities. The researchers found "considerable variability in the frequency of inappropriate care and that many of the activities identified in the Good Stewardship 'Top 5' lists have marginal impact on health care costs. Approximately 86% of the costs associated with the 'Top 5' lists were from the use of brand name instead of generic statins" for the treatment of high cholesterol. "Although generic drug substitutions may appear to be a 'low hanging fruit' for drug savings, numerous efforts have already been made ... to achieve this goal. In this light, our data suggest that considerably more work is needed to reduce the costs associated with brand name statin use" (Kale, et. al., 10/1).