Date of Award

Fall 2019

Document Type

Open Access Dissertation

Department

Health Services and Policy Management

First Advisor

Melanie Cozad

Abstract

Background: COPD patients have poor adherence to prescribed treatment. Individuals with COPD have higher out-of-pocket treatment cost than individuals without COPD. The significant out of pocket COPD related treatment cost can lead to prescription drug non-adherence especially for individuals without health insurance or prescription drug coverage.

Significance: Since the implementation of Medicare Part D on January 1, 2006, there are no studies that have used national data to evaluate the association of health insurance and prescription drug coverage on cost related non-adherence and hospitalization among individuals 50-64 years old with COPD compared to individuals 65 years and older with COPD. Medicare and Medicare Part D program are health and prescription drug plans that provide insurance coverage for US citizens 65 years and older and younger individuals with disabilities. There are no health insurance or prescription drug plans designed specifically for individuals 50-64 years old with chronic diseases. These individuals may be more vulnerable to cost related prescription drug non-adherence compared to individuals 65 years and older. Further research is necessary to determine if the association of insurance status and prescription drug coverage on cost related prescription drug adherence is different among individuals 50-64 years old with COPD versus individuals 65 years and older with COPD.

Objective: The objective of this study was to evaluate the association of insurance status on cost related non-adherence and cost related non-adherence hospitalization, by age groups 50-64 and 65 or older among a nationally representative sample of individuals with an established diagnosis of COPD.

Methods: The data source used for this study is the 2010 HRS Survey. Multivariate regression analysis is conducted to assess the association of health insurance and prescription drug coverage on cost-related non-adherence and cost-related non-adherence on hospitalization across age-related groups of individuals with COPD.

Results: COPD respondents 65 years of age and older with no prescription drug coverage had lower odds (OR= 0.64 [0.46-0.90]) of reporting CRN than their counterparts with prescription drug coverage. COPD respondents between the age of 50- 64 years old had higher odds of reporting (OR= 3.01 [2.80-4.35]) CRN than COPD respondents 65 years and older. CRN was not statistically significant (47.1% among CRN respondents, 43.1% among others; p = 0.245) nor associated with the odds of hospitalization in the past two years (OR = 0.78 [0.57-1.07). COPD respondents between the age of 50-64 years old had lower odds (OR= 0.65 [0.49-0.86]) being hospitalized in the last two years than COPD respondents 65 years and older. COPD respondents 50 years and older with no prescription drug coverage had lower odds (OR=0.77 [0.60-0.99]) of being hospitalized in the past two years than similar respondents with prescription drug coverage, particularly those 65 years and older (OR= 0.64 [0.46-0.90]).

Conclusion: The evaluation of health insurance and prescription drug coverage on cost- related non-adherence across age related groups of individuals with COPD can help clinicians and policy makers understand how health insurance related policies impact COPD management and COPD related hospitalization. The study results demonstrate the need for expansion of public health insurance and prescription drug coverage to individuals with progressive chronic diseases that require continuous drug treatment regardless of age.

Rights

© 2019, Shamika Martin Walls

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