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Prescription Drug Coverage and Medicare Spending among U.S. Elderly

Author

Listed:
  • Baoping Shang

    (Health Policy Center, The Urban Institute)

  • Dana Goldman

    (School of Policy, Planning and Development, University of Southern California)

Abstract

The introduction of Medicare Part D has generated interest in the cost of providing drug coverage to the elderly. Of paramount importance—often unaccounted for in budget estimates—are the salutary effects that increased prescription drug use might have on other Medicare spending. This paper uses longitudinal data from the Medicare Current Beneficiary Survey to estimate how prescription drug benefits affect Medicare spending. We compare spending and service use for Medigap enrollees with and without drug coverage. Owing to concerns about selection, we use variation in supply-side regulations of the individual insurance market—including guaranteed issue and community rating—as instruments for prescription drug coverage. We employ a discrete factor model to control for individual-level heterogeneity that might induce bias in the effects of drug coverage. We find Medigap prescription drug coverage significantly increases drug spending and reduces Medicare Part A spending. Medigap prescription drug coverage reduces Medicare Part B spending, but the estimates are not statistically significant. Furthermore, the substitution effect decreases as income rises, and thus provides support for the low-income assistance program of Medicare Part D.

Suggested Citation

  • Baoping Shang & Dana Goldman, 2010. "Prescription Drug Coverage and Medicare Spending among U.S. Elderly," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 35(4), pages 539-567, October.
  • Handle: RePEc:pal:gpprii:v:35:y:2010:i:4:d:10.1057_gpp.2010.21
    DOI: 10.1057/gpp.2010.21
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    References listed on IDEAS

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    1. Thomas Buchmueller & John Dinardo, 2002. "Did Community Rating Induce an Adverse Selection Death Spiral? Evidence from New York, Pennsylvania, and Connecticut," American Economic Review, American Economic Association, vol. 92(1), pages 280-294, March.
    2. Bhattacharya, Jayanta & Goldman, Dana & Sood, Neeraj, 2003. "The link between public and private insurance and HIV-related mortality," Journal of Health Economics, Elsevier, vol. 22(6), pages 1105-1122, November.
    3. Hurd, Michael D. & McGarry, Kathleen, 1997. "Medical insurance and the use of health care services by the elderly," Journal of Health Economics, Elsevier, vol. 16(2), pages 129-154, April.
    4. Harris, Katherine M. & Keane, Michael P., 1998. "A model of health plan choice:: Inferring preferences and perceptions from a combination of revealed preference and attitudinal data," Journal of Econometrics, Elsevier, vol. 89(1-2), pages 131-157, November.
    5. Lillard, L.A. & Rogowski, J. & Kington, R., 1999. "Insurance Coverage for Prescription Drugs: Effects on Use and Expenditures in the Medicare Population," Papers 99-09, RAND - Labor and Population Program.
    6. Tomas J. Philipson & Dana Goldman, 2007. "Integrated Insurance Design in the Presence of Multiple Medical Technologies," American Economic Review, American Economic Association, vol. 97(2), pages 427-432, May.
    7. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
    8. Ettner, Susan L., 1997. "Adverse selection and the purchase of Medigap insurance by the elderly," Journal of Health Economics, Elsevier, vol. 16(5), pages 543-562, October.
    9. Lillard, L.A. & Rogowski, J. & Kington, R., 1999. "Insurance Coverage for Prescription Drugs: Effects on Use and Expenditures in the Medicare Population," Papers 99-09, RAND - Labor and Population Program.
    10. Mroz, Thomas A., 1999. "Discrete factor approximations in simultaneous equation models: Estimating the impact of a dummy endogenous variable on a continuous outcome," Journal of Econometrics, Elsevier, vol. 92(2), pages 233-274, October.
    11. Zhou Yang & Donna B. Gilleskie & Edward C. Norton, 2004. "Prescription Drugs, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics," NBER Working Papers 10964, National Bureau of Economic Research, Inc.
    12. Wolfe, John R. & Goddeeris, John H., 1991. "Adverse selection, moral hazard, and wealth effects in the medigap insurance market," Journal of Health Economics, Elsevier, vol. 10(4), pages 433-459.
    13. Goldman Dana P & Joyce Geoffrey F & Malkin Jesse Dylan, 2002. "The Costs of A Medicare Prescription Drug Benefit," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 2(1), pages 1-18, April.
    14. M. Kate Bundorf & Kosali I. Simon, 2006. "The Effects of Rate Regulation on Demand for Supplemental Health Insurance," American Economic Review, American Economic Association, vol. 96(2), pages 67-71, May.
    15. Dana P. Goldman, 1995. "Managed Care as a Public Cost-Containment Mechanism," RAND Journal of Economics, The RAND Corporation, vol. 26(2), pages 277-295, Summer.
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