摘要：Objectives. The Balanced Budget Act of 1997 authorized Medicare to expand the coverage of glucose monitors and strips to non–insulin users with diabetes and self-management training to non–hospital-based programs. We examined the impact of this expansion on self-monitoring of blood glucose among Medicare beneficiaries who were not using insulin to treat their diabetes. Methods. With data from the 1996–2000 Behavioral Risk Factor Surveillance System and a logistic regression model using a complex survey design, we compared the probability of self-monitoring of blood glucose among Medicare beneficiaries at the frequency recommended by the American Academy of Family Physicians’ clinical guidelines before and after the Medicare expansion. We also compared the change in the frequency of self-monitoring of blood glucose during these periods between Medicare beneficiaries and persons with private insurance by using a difference-in-difference model. Results. Medicare expansion was positively associated with the probability of self-monitoring of blood glucose for both Medicare beneficiaries and persons with private insurance; the magnitude was between 7.1 and 16.6 percentage points. Conclusions. The Medicare expansion effectively increased the frequency of the recommended self-monitoring of blood glucose in the Medicare population. Diabetes is a common, growing, and costly disease in the United States. 1 , 2 A disproportionate burden of diabetes occurs among persons aged 65 and older, because of higher disease prevalence among this age group than among younger age groups. In 2004, the prevalence rate of diabetes was 18.1% among persons aged 65 to 74 years and 15.7% among persons aged 75 and older. 3 During 2002, the annual direct medical costs for persons aged 65 and older ($47.6 billion) corresponded to an estimated 52% of the total direct medical costs for people with diabetes ($91.8 billion). 4 Medicare, the insurer for people aged 65 years and older and for people of all ages who have certain disabilities or end-stage renal disease, bears a large proportion of the direct medical costs of diabetes. During 2005, 32% of the total Medicare expenditure was attributable to treating illness among persons with diabetes. 5 Optimal glucose control can prevent or delay diabetes-related complications and thus may potentially reduce or postpone medical costs associated with treating these complications. Self-management education and the self-monitoring of blood glucose level are effective tools for achieving good glucose control. 6 – 13 The federal government passed the Balanced Budget Act of 1997, effective on July 1, 1998, which expanded the Medicare benefits on diabetes. Before the expansion, Medicare covered blood glucose monitors and strips only for insulin users and covered outpatient self-management training only for hospital-based programs. The Balanced Budget Act expanded the coverage of glucose monitors and strips to non–insulin users, allowing 100 strips per 3 months, and expanded the coverage of self-management training to non–hospital-based programs. All coverage was subject to a 20% copayment. 14 – 16 We evaluated the impact of the Medicare expansion on self-monitoring of blood glucose among beneficiaries who were not on insulin treatment, the population on which the policy change had the most direct impact.
