Effect of Health Shocks on Statin Adherence: Evidence from Medicaid Claims

Johnson, Courtney

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Overview

Year:: 2024
Contributor:: Johnson, Courtney (creator); Galárraga, Omar (Advisor); Shireman, Theresa (Reader); Trivedi, Amal (Reader); Brown University. Department of Health Services, Policy and Practice (sponsor)
Genre:: theses
Subject:: Medication Adherence; Statins; Econometrics--Research; Medicaid; Myocardial infarction; health services research
Extent:: xiii, 102 p.

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Abstract:: Experiencing a health shock, a significant medical event that does not result in mortality but requires hospitalization or significant medical intervention, could prompt adoption of healthy behaviors. While a health shock like myocardial infarction (MI) hospitalization may improve adherence to cardiovascular medications, this change may be temporary. This dissertation examines the impact of MI hospitalization on statin adherence among Medicaid beneficiaries, and how Medicaid prescription cap policies and living with HIV, impact post-MI statin adherence. For this analysis, we use Medicaid administrative claims data of beneficiaries in 14 states from 2001 to 2015. Chapter 1 uses a quasi-experimental staggered-entry difference-in-differences analysis, modeled as an event study, to compare monthly statin adherence in beneficiaries with MI hospitalization versus without (MI versus proxy cohort), in the month pre- and post-MI. Chapter 2 uses a quasi-experimental triple differences analysis to compare monthly statin adherence among the MI versus proxy cohort, in Medicaid prescription cap and non-cap states, in the 12 months pre- and post-MI. Chapter 3 focuses on a cohort of beneficiaries living with HIV, and uses the same research strategy as chapter 2. Chapter 1 finds that MI hospitalization increased statin adherence. Compared to the proxy cohort, the MI cohort had statin adherence 9.3 – 15.7 percentage points (pp) higher in the month following the health shock versus before. Chapter 2 finds that cap policies decreased adherence by 3.3% among beneficiaries hospitalized for MI. Beneficiaries in cap states had statin adherence 2.1 pp lower post versus pre-MI, compared to concurrent changes in beneficiaries in non-cap states. Chapter 3 finds that among beneficiaries with HIV and hospitalized for MI, cap policies decreased adherence by 14.9%. Beneficiaries in cap states had statin adherence 10.3 pp lower post versus pre-MI hospitalization, compared to concurrent changes in beneficiaries in non-cap states. Although statin adherence increased post-MI, cap policies negatively impacted adherence. These results suggest post-hospitalization is an important time to implement medication adherence interventions. Additionally, Medicaid policies expanding access to affordable medications, especially for beneficiaries with HIV and other chronic conditions, may improve adherence.
Notes:: Thesis (Ph. D.)--Brown University, 2024

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Citation

Johnson, Courtney, "Effect of Health Shocks on Statin Adherence: Evidence from Medicaid Claims" (2024). Health Services, Policy & Practice Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:s56wxagm/

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Health Services, Policy & Practice Theses and Dissertations

Theses and Dissertations for the Health Services, Policy & Practice department.
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