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Objective: To analyze factors associated with changes in prescription drug use and expenditures in the United States from 1999 to 2016, a period of rapid growth, deceleration, and resumed above-average growth. Data Sources/Study Setting: The Medical Expenditure Panel Survey (MEPS), containing household and pharmacy information on over five million prescription drug fills. Study Design: We use nonparametric decomposition to analyze drug use, average payment per fill, and per capita expenditure, tracking the contributions over time of socioeconomic characteristics, health status and treated conditions, insurance coverage, and market factors surrounding the patent cycle. Data Collection/Extraction Methods: Medical Expenditure Panel Survey data were combined with information on drug approval dates and patent status. Principal Findings: Per capita utilization increased by nearly half during 1999-2016, with changes in health status and treated conditions accounting for four-fifths of the increase. In contrast, per capita expenditures more than doubled, with individual characteristics only explaining one-third of the change. Other drivers of spending during this period include the changing pipeline of new drugs, drugs losing exclusivity, and changes in generic competition. Conclusions: Long-term trends in treated conditions were the fundamental drivers of medication use, whereas factors involving the patent cycle accelerated and decelerated spending growth relative to trends in use. KEYWORDS decomposition, expenditure growth, prescription drugs, 1 | INTRODUCTION As of 2016, national health expenditures totaled $3.3 trillion or 17.9 percent of gross domestic product. (1) Health care spending already places considerable strain on the budgets [...]

Objective. To examine the determinants of potentially inappropriate medication (PIM) use. Data Sources/Study Setting. U.S. nationally representative data on (n = 16,588) noninstitutionalized older adults (age [greater than or equal [...]

Objectives. To provide updated estimates of narrow- and broad-spectrum antibiotic use among U.S. children. Data Sources. Linked nationally representative data from the 2004-2010 Medical Expenditure Panel Survey Household Component and the 2000 Decennial Census. Study Design. Relationships between individual-, family-, and community-level characteristics and the use of antibiotics overall and in the treatment of respiratory tract infections (RTIs) are examined using multinomial choice models. Principal Findings. More than one quarter (27.3 percent) of children used at least one antibiotic each year with 12.8 percent using broad-spectrum and 18.5 percent using narrow-spectrum antibiotics. Among children with use, more than two-thirds (68.6 percent) used antibiotics to treat RTIs. Multivariate models revealed many differences across groups in antibiotic use, overall and in the treatment of RTIs. Differential use was associated with a broad range of factors related to need (e.g., age, health status), resources (e.g., insurance status, parental income, and education), race-ethnicity, and Census region. Conclusions. Despite encouraging reports regarding the declining use of antibiotics, large differences in use associated with resources, race-ethnicity, and Census regions suggest a need for further improvement in the judicious and appropriate prescribing of antibiotics for U.S. children. Key Words. Children, antibiotics, narrow- and broad-spectrum, multinomial choice model, Antibiotics, a class of chemotherapeutic agents that are used to treat the underlying causes of infectious diseases by inhibiting microbial growth and survival, have been instrumental in drastically reducing illness [...]

Objective. To examine racial-ethnic differences in asthma controller medication use among insured U.S. children. Data Sources. Linked nationally representative data from the Medical Expenditure Panel Survey (2005-2008), the 2000 Decennial Census, and the National Health Interview Survey (2004-2007). Study Design. The study quantifies the portion of racial-ethnic differences in children's controller use that are attributable to differences in need, enabling and predisposing characteristics. Principal Findings. Non-Hispanic black and Hispanic children were less likely to use controllers than non-Hispanic white children. Blinder-Oaxaca decomposition results indicated that observable characteristics explain less than 40 percent of the overall differential in controller use between non-Hispanic whites and non-Hispanic blacks. In contrast, observable characteristics explain more than two-thirds (71.3 percent) of the overall non-Hispanic white-Hispanic differential in controller use. For non-Hispanic blacks, a majority of the explained differential in controller use were attributed to enabling characteristics. For Hispanics, a significant portion of the explained differential in controller use was attributed to predisposing characteristics. In addition, a larger portion of the differential in controller use was explained by observable characteristics for publicly insured non-Hispanic black and Hispanic children. Conclusions. The large observed differences in controller use highlight the continuing challenges of ensuring that all U.S. children have access to quality asthma care. Key Words. Children, race-ethnicity, insurance status, asthma controller medications, decomposition, Asthma is a common chronic disease among U.S. children, characterized by chronic airway inflammation, and which results in recurring episodes of coughing, wheezing, breathlessness, and chest tightness. Asthma imposes significant [...]

Objective. To estimate 2012 tax expenditures for employer-sponsored insurance (ESI) in the United States and to explore the sensitivity of estimates to assumptions regarding the incidence of employer premium contributions. Data Sources. Nationally representative Medical Expenditure Panel Survey data from the 2005-2007 Household Component (MEPS-HC) and the 2009-2010 Insurance Component (MEPS IC). Study Design. We use MEPS HC workers to construct synthetic workforces for MEPS IC establishments, applying the workers' marginal tax rates to the establishments' insurance premiums to compute the tax subsidy, in aggregate and by establishment characteristics. Simulation enables us to examine the sensitivity of ESI tax subsidy estimates to a range of scenarios for the within-firm incidence of employer premium contributions when workers have heterogeneous health risks and make heterogeneous plan choices. Principal Findings. We simulate the total ESI tax subsidy for all active, civilian U.S. workers to be $257.4 billion in 2012. In the private sector, the subsidy disproportionately flows to workers in large establishments and establishments with predominantly high wage or full-time workforces. The estimates are remarkably robust to alternative incidence assumptions. Conclusions. The aggregate value of the ESI tax subsidy and its distribution across firms can be reliably estimated using simplified incidence assumptions. Key Words. Microsimulation, health insurance, tax subsidy, For many readers the term 'microsimulation' may connote the use of data on persons (or establishments) to evaluate the possible consequences of a new or proposed policy. Such a definition, [...]