Medicare’s Policy on Carotid Stents Limited Use to Hospitals Meeting Quality Guidelines Yet Did Not Hurt Disadvantaged Groups

摘要

Medicare began covering carotid arterial stents in 2005 under an innovative policy that required hospitals to meet quality-of-care benchmarks prior to seeking reimbursement. By limiting hospital adoption, this policy may have inadvertently reduced availability of the stents among historically disadvantaged groups of Medicare beneficiaries. However, our analysis of hospitals that provided stents in 2005–2007 demonstrated that while 19–38 percent fewer hospitals offered them compared to similar technologies, availability of stents in localities with substantial poor, black, and/or rural populations was comparable to other areas. Medicare’s coverage policy was followed by limited diffusion of new technology without adverse equity consequences.