Prescription Drug Policies and Health Care: Studies on Medicare Part D Program, State Prescription Drug Monitoring Programs, and Off-label Prescribing Practices
Open Access
- Author:
- Nam, Young Hee
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 12, 2014
- Committee Members:
- Dennis G Shea, Dissertation Advisor/Co-Advisor
Dennis G Shea, Committee Chair/Co-Chair
Pamela Farley Short, Committee Member
John Raymond Moran Jr., Committee Member
Douglas L Leslie, Committee Member - Keywords:
- Prescription drug policies
Medicare Part D
PDMPs
Off-label prescription - Abstract:
- This dissertation investigated three prescription drug policy areas, aiming to fill in the gap in the research toward reforming health care in a positive direction: (1) Medicare Part D program, (2) state prescription drug monitoring programs (PDMPs), and (3) off-label prescribing practices. The Medicare Part D program study examined Part D’s effects on health outcomes and Medicare spending for Parts A and B among Part D beneficiaries who previously lacked prescription drug coverage, using Medicare Current Beneficiary Survey (MCBS) Cost and Use files for 2004-2007, which are combined with Medicare claims and other administrative data, and a difference-in-differences model, estimating Part D’s treatment effects between 2005 and 2007. The results showed that Part D benefits did not have statistically significant effects on health outcomes and Medicare Parts A and B spending among the study population. In subpopulation analysis, people who previously had hypertension showed slightly, but significantly, decreased general health status and increased Medicare spending for home health agency services. The second study on PDMPs examined PDMPs’ effects in reducing drug overdose mortality rates in the United States during 1999-2010. The main data used are (1) de-identified individual-level mortality data obtained from the National Center for Health Statistics (NCHS) and (2) bridged-race population estimates data produced by the U.S. Census Bureau in collaboration with NCHS. The PDMP effects on drug overdose mortality rates were estimated using three different fixed effects models. The results suggested that PDMPs had little effect in reducing drug overdose mortality rates and might be related to unintended consequences, such as increased drug overdose deaths from illegal or unspecified drugs. The third study on off-label prescribing of drugs aimed to investigate individuals’ understanding, experience, and preferences on off-label prescribing of drugs from the perspective of patient-centered care, employing concurrent, embedded mixed methods. The primary quantitative and qualitative data were collected through a survey, on-line and off-line, among community-dwelling senior citizens age 60 and older residing in a county in Pennsylvania. The study found that an absolute majority of individuals (96 percent of the respondents) wanted to be informed of off-label prescription, and the reasons included: to make informed decision; to determine the existence and the level of scientific evidence supporting the off-label drug use; to have a partnership with physicians in their treatment; and because of their belief that making informed decisions is a patient’s right.