Net health plan savings from reference pricing for angiotensin-converting enzyme inhibitors in elderly British Columbia residents.

Abstract:

BACKGROUND:Reference drug pricing (RP) is a cost-sharing strategy commonly used to control drug expenditures. Under RP, a benefit plan fully reimburses medications that are equally or less expensive than the reference price, and requires patients to pay the extra cost of therapeutically equivalent but higher priced drugs. Critics argued that drug plan savings are offset by administrative costs and increased spending on other health services. OBJECTIVE:We evaluated net healthcare savings in beneficiaries >or=65 years from the perspective of the British Columbia provincial health insurance system after it applied RP to angiotensin-converting enzyme (ACE) inhibitors in 1997. METHODS:We estimated savings in new users of antihypertensives after the start of RP plus associated administrative costs and savings from reductions in retail drug prices. Findings were integrated with earlier results on the consequences of RP on expenditures for drugs, physicians, and hospitalizations among all seniors who used ACE inhibitors before the introduction of RP. RESULTS:During the first year after the implementation of RP, savings for continuous users were CAN dollars 6.0 million. Savings for new users were dollars 0.2 million. Approximately five sixths thereof were achieved by utilization changes and one sixth by cost shifting to patients. There were no savings through drug price changes. Administering RP cost dollars 0.42 million. Overall net savings were estimated to be dollars 5.8 million during the first year after the start of RP. The magnitude of these savings is equal to 6% of all cardiovascular drug expenditures in seniors. After 10 years, approximately 50% of savings will be achieved by new users. CONCLUSION:We observed substantial net savings from RP for ACE inhibitors for the provincial health insurance system in British Columbia, although there were generous exemptions from the policy. In other jurisdictions, savings could be higher if drug prices decline after the start of reference pricing.

journal_name

Med Care

journal_title

Medical care

authors

Schneeweiss S,Dormuth C,Grootendorst P,Soumerai SB,Maclure M

doi

10.1097/01.mlr.0000129497.10930.a2

keywords:

subject

Has Abstract

pub_date

2004-07-01 00:00:00

pages

653-60

issue

7

eissn

0025-7079

issn

1537-1948

pii

00005650-200407000-00006

journal_volume

42

pub_type

杂志文章
  • Dimensions of consumer-assessed quality of Medicare managed-care health plans.

    abstract:OBJECTIVES:We investigated relationships at the health-plan level among member ratings of and reports on plans in the Consumer Assessment of Health Plans Survey (CAHPS). We sought a more parsimonious description of the reports that can be used in analyses of the distribution and correlates of consumer-assessed quality....

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200002000-00006

    authors: Zaslavsky AM,Beaulieu ND,Landon BE,Cleary PD

    更新日期:2000-02-01 00:00:00

  • Using health status measures in the hospital setting: from acute care to 'outcomes management'.

    abstract::In recent years, employers, insurers, and government purchasers have paid increased attention to the measurement of patient outcomes and health status. Such interest is stimulated less by policy or quality concerns than by the need to reduce health care expenditures. Any expected benefits which might accrue from healt...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199205001-00006

    authors: Lansky D,Butler JB,Waller FT

    更新日期:1992-05-01 00:00:00

  • Benchmarking Veterans Affairs Medical Centers in the delivery of preventive health services: comparison of methods.

    abstract:OBJECTIVE:To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expe...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200206000-00011

    authors: Doebbeling BN,Vaughn TE,Woolson RF,Peloso PM,Ward MM,Letuchy E,BootsMiller BJ,Tripp-Reimer T,Branch LG

    更新日期:2002-06-01 00:00:00

  • Underutilization of antihypertensive drugs and associated hospitalization.

    abstract::The association of underutilization of drugs prescribed for the treatment of hypertension and acute-care hospital readmissions was evaluated. The data base consisted of computerized hospitalization records and computerized out-patient pharmacy records, checked by chart audit for validity. The number of days' supply of...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198912000-00007

    authors: Maronde RF,Chan LS,Larsen FJ,Strandberg LR,Laventurier MF,Sullivan SR

    更新日期:1989-12-01 00:00:00

  • Activating patients for smoking cessation through physician autonomy support.

    abstract:OBJECTIVE:Test whether physicians' counseling patients for smoking cessation with an autonomy supportive rather than controlling style would increase patients' active involvement in the counseling session and increase maintained abstinence. DESIGN:Randomized trial of 27 community-based physicians using two interview s...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00005650-200108000-00007

    authors: Williams GC,Deci EL

    更新日期:2001-08-01 00:00:00

  • Differential item functioning (DIF) and the Mini-Mental State Examination (MMSE). Overview, sample, and issues of translation.

    abstract:BACKGROUND:Various forms of differential item functioning (DIF) in the Mini-Mental State Examination (MMSE) have been identified. Items have been found to perform differently for individuals of different educational levels, racial/ethnic groups, and/or of groups whose first language is not English. The articles in this...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.mlr.0000245181.96133.db

    authors: Ramirez M,Teresi JA,Holmes D,Gurland B,Lantigua R

    更新日期:2006-11-01 00:00:00

  • Disclosure of information to patients in medical care.

    abstract::It is generally agreed that patients have a right to be adequately informed. However, little is known about the extent to which doctors and patients agree about information that should be disclosed. We studied what patients want to know, as contrasted with what physicians report actually disclosing, in a population of...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198107000-00003

    authors: Faden RR,Becker C,Lewis C,Freeman J,Faden AI

    更新日期:1981-07-01 00:00:00

  • A national catalog of preference-based scores for chronic conditions in the United States.

    abstract:BACKGROUND:The variability in preferences used in quality-adjusted life-years estimation jeopardizes the comparability of cost-effectiveness analyses and has led the Panel on Cost-Effectiveness in Health and Medicine (the PCEHM) to call for a catalog of "off-the-shelf" preference weights associated with conditions that...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000172050.67085.4f

    authors: Sullivan PW,Lawrence WF,Ghushchyan V

    更新日期:2005-07-01 00:00:00

  • Predicting psychosocial risk in patients with breast cancer.

    abstract::Breast cancer is the most common neoplasm in North American women. The psychosocial impact of breast cancer has been extensively studied, and a number of investigators have attempted to characterize women who are at high risk for increased psychosocial morbidity. Although a detailed interview performed by a profession...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-199305000-00004

    authors: Ganz PA,Hirji K,Sim MS,Schag CA,Fred C,Polinsky ML

    更新日期:1993-05-01 00:00:00

  • Opportunity or Burden? A Behavioral Framework for Patient Engagement.

    abstract:BACKGROUND:Engaging patients as partners in their care is clinically appealing, yet challenging to implement, and we lack a measurement framework that is applicable to vulnerable populations. To address this gap, we conducted a qualitative study to refine a conceptual framework that reflects an individual's propensity ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001240

    authors: Kimerling R,Lewis ET,Javier SJ,Zulman DM

    更新日期:2020-02-01 00:00:00

  • The effect of improving primary care depression management on employee absenteeism and productivity. A randomized trial.

    abstract:OBJECTIVE:To test whether an intervention to improve primary care depression management significantly improves productivity at work and absenteeism over 2 years. SETTING AND SUBJECTS:Twelve community primary care practices recruiting depressed primary care patients identified in a previsit screening. RESEARCH DESIGN:...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-200412000-00007

    authors: Rost K,Smith JL,Dickinson M

    更新日期:2004-12-01 00:00:00

  • Differential effect of early or late implementation of prior authorization policies on the use of Cox II inhibitors.

    abstract:BACKGROUND:State Medicaid programs introduce many types of prescribing restrictions to manage pharmaceutical use and expenditure. Little is known about the differential effect of implementing prior authorization (PA) policies at market entry versus waiting until several years later when prescribing behavior may already...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000204056.31664.36

    authors: Roughead EE,Zhang F,Ross-Degnan D,Soumerai S

    更新日期:2006-04-01 00:00:00

  • "Counterintuitive" preferences in health-related quality-of-life measurement.

    abstract::The published preferences for scale steps in a health-related quality-of-life scale have been noted to be contrary to some prior assumptions about their rank ordering. The differences noted are actually statistically nonsignificant, and the observed ordering has a clear intuitive explanation. Several alternative expla...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198205000-00008

    authors: Bush JW,Anderson JP,Kaplan RM,Blischke WR

    更新日期:1982-05-01 00:00:00

  • Recurrence and care seeking after acute back pain: results of a long-term follow-up study. North Carolina Back Pain Project.

    abstract:OBJECTIVE:To explore the relationship between type of initial care as well as the likelihood of recurrence and consequent care seeking behavior. RESEARCH DESIGN:Prospective observational cohort recruited from 208 randomly selected North Carolina practices. Cohort study examined the recurrence of low back pain among pa...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199902000-00006

    authors: Carey TS,Garrett JM,Jackman A,Hadler N

    更新日期:1999-02-01 00:00:00

  • The future of kidney transplantation. The effect of improvements in survival rate on the shortage of donated kidneys.

    abstract::New drugs and other medical advances in organ transplantation are expected to increase the rate of retention of transplanted kidneys, or grafts, and therefore also raise patient survival rates. In particular, the immunosuppressive drug cyclosporine has been found to reduce the likelihood of rejection of a transplanted...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Ruth RJ,Wyszewianski L,Campbell DA

    更新日期:1987-03-01 00:00:00

  • Family structure and children's use of ambulatory physician services.

    abstract::The purpose of this article is to examine children's use of ambulatory physician services in relation to three dimensions of family life: maternal employment, single-parent versus two-parent households, and the presence of a nuclear or extended family. Data from the National Medical Care Expenditure Survey show that m...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198504000-00007

    authors: Cafferata GL,Kasper JD

    更新日期:1985-04-01 00:00:00

  • Outpatient patterns of care and longitudinal intensity of antiretroviral therapy for HIV-infected drug users.

    abstract:OBJECTIVE:To examine the association of drug users' outpatient patterns of care with subsequent intensity of antiretroviral therapy (ART). MATERIALS AND METHODS:Annual types of ART in 8897 New York State Medicaid drug users who were prescribed ART for > or =6 months in 1996 or 1997 were determined. From pharmacy claim...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200210000-00014

    authors: Laine C,Hauck WW,Turner BJ

    更新日期:2002-10-01 00:00:00

  • Health insurance coverage and the risk of decline in overall health and death among the near elderly, 1992-2002.

    abstract:BACKGROUND:Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time. OBJECTIVE:We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death fro...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000199696.41480.45

    authors: Baker DW,Sudano JJ,Durazo-Arvizu R,Feinglass J,Witt WP,Thompson J

    更新日期:2006-03-01 00:00:00

  • The impact of the SARS outbreak on an urban emergency department in Taiwan.

    abstract:OBJECTIVE:Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. METHODS:The patients' characteristics in an urban ED were collect...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200502000-00010

    authors: Chen WK,Cheng YC,Chung YT,Lin CC

    更新日期:2005-02-01 00:00:00

  • Measuring adequacy of physician performance. A preliminary comparison of four methods in ambulatory care of chronic obstructive pulmonary disease.

    abstract::Issues that arise in the development of methods for measuring adequacy of physician performance (MAPP) are discussed. The comparative content validity, scorability, cost, and acceptability of four MAPP strategies are assessed using a sample of clinic-based physicians treating 30 patients with chronic obstructive pulmo...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章

    doi:

    authors: Kemeny ME,Hargreaves WA,Gerbert B,Stone GC,Gullion DS

    更新日期:1984-07-01 00:00:00

  • Validly interpreting patients' reports: using bifactor and multidimensional models to determine whether surveys and scales measure one or more constructs.

    abstract:INTRODUCTION:Validly interpreting scores based on patients' reports of their experiences using scales depends on a valid scoring system. The possibility exists that, although the creators of a scale intended to create a scale measuring a single construct, the questions may seem to measure more than one construct. Howev...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318266519e

    authors: Carle AC,Weech-Maldonado R

    更新日期:2012-09-01 00:00:00

  • Physician practice revenues and use of information technology in patient care.

    abstract:OBJECTIVES:Although information technology (IT) may improve efficiency and quality of patient care, the adoption of clinical IT by physicians has been limited. This study investigates the relationships between physician practice revenue and use of clinical IT. RESEARCH DESIGN:We undertook a cross-sectional analysis of...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000241089.98461.e5

    authors: Furukawa MF,Ketcham JD,Rimsza ME

    更新日期:2007-02-01 00:00:00

  • Comparison of Nurse Staffing Measurements in Staffing-Outcomes Research.

    abstract:BACKGROUND:Investigators have used a variety of operational definitions of nursing hours of care in measuring nurse staffing for health services research. However, little is known about which approach is best for nurse staffing measurement. OBJECTIVE:To examine whether various nursing hours measures yield different mo...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318277eb50

    authors: Park SH,Blegen MA,Spetz J,Chapman SA,De Groot HA

    更新日期:2015-01-01 00:00:00

  • Consumerism in health care. Prevalence and predictors.

    abstract::Current efforts to contain health care costs include a variety of strategies aimed at the users of health services. These approaches attempt to encourage users to be more cost-conscious and to shop for lower-cost services and more efficient health care plans. The primary method for achieving this is by increasing the ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198711000-00001

    authors: Hibbard JH,Weeks EC

    更新日期:1987-11-01 00:00:00

  • Does practice make perfect? Examining the relationship between hospital surgical volume and outcomes for hip fracture patients in Quebec.

    abstract:OBJECTIVES:Most tests of the practice-makes-perfect hypothesis have used cross-sectional data, which reveal that patients receiving surgery in high-volume hospitals tend to experience better postsurgery outcomes. This study uses longitudinal data to explicitly examine whether any given hospital's patient outcomes chang...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199806000-00012

    authors: Hamilton BH,Ho V

    更新日期:1998-06-01 00:00:00

  • Assessing Residual Bias in Estimating Influenza Vaccine Effectiveness: Comparison of High-dose Versus Standard-dose Vaccines.

    abstract:BACKGROUND:Estimating influenza vaccine effectiveness using an unvaccinated comparison group may result in biased effect estimates. OBJECTIVES:To explore the reduction of confounding bias in an active comparison of high-dose versus standard-dose influenza vaccines, as compared with vaccinated versus unvaccinated compa...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001018

    authors: Butler AM,Layton JB,Krueger WS,Kshirsagar AV,McGrath LJ

    更新日期:2019-01-01 00:00:00

  • Physician decision making and variation in hospital admission rates for suspected acute cardiac ischemia. A tale of two towns.

    abstract::The authors tested the "uncertainty hypothesis," which holds that variations in rates of hospitalization or surgeries across small geographic areas reflect differences in physicians' decision making when confronting uncertainty. A small-areas variation analysis of suspected acute cardiac ischemia (ACI) admissions in n...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199411000-00002

    authors: Green LA,Becker MP

    更新日期:1994-11-01 00:00:00

  • Comparability of patient-reported health status: multicountry analysis of EQ-5D responses in patients with type 2 diabetes.

    abstract:BACKGROUND:Valid and comparable measures of health outcomes are needed for clinical trials, studies on quality of healthcare, and population health monitoring. OBJECTIVE:To examine comparability of patient-reported health status across populations. RESEARCH DESIGN:Logistic regression analysis of health status across ...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/MLR.0b013e3182239489

    authors: Salomon JA,Patel A,Neal B,Glasziou P,Grobbee DE,Chalmers J,Clarke PM

    更新日期:2011-10-01 00:00:00

  • Knowledge management and informatics considerations for comparative effectiveness research: a case-driven exploration.

    abstract:BACKGROUND:As clinical data are increasingly collected and stored electronically, their potential use for comparative effectiveness research (CER) grows. Despite this promise, challenges face those wishing to leverage such data. In this paper we aim to enumerate some of the knowledge management and informatics issues c...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31829b1de1

    authors: Embi PJ,Hebert C,Gordillo G,Kelleher K,Payne PR

    更新日期:2013-08-01 00:00:00

  • Influencing behavior of physicians ordering laboratory tests: a literature study.

    abstract::There are various reasons why physicians order laboratory tests. Earlier studies have shown that in many cases test-ordering behavior lacks efficiency, resulting in excessive laboratory utilization. Throughout the years various attempts have been made to improve this situation. This review, based on the literature of ...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/00005650-199309000-00003

    authors: Axt-Adam P,van der Wouden JC,van der Does E

    更新日期:1993-09-01 00:00:00