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Jella TK, Cwalina TB, Schmidt JE, Wu VS, Yong TM, Vallier HA. Do Patients Reporting Fractures Experience Food Insecurity More Frequently Than the General Population? Clin Orthop Relat Res 2023; 481:849-858. [PMID: 36728256 PMCID: PMC10097583 DOI: 10.1097/corr.0000000000002514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The economic burden of traumatic injuries forces families into difficult tradeoffs between healthcare and nutrition, particularly among those with a low income. However, the epidemiology of food insecurity among individuals reporting having experienced fractures is not well understood. QUESTIONS/PURPOSES (1) Do individuals in the National Health Interview Survey reporting having experienced fractures also report food insecurity more frequently than individuals in the general population? (2) Are specific factors associated with a higher risk of food insecurity in patients with fractures? METHODS This retrospective, cross-sectional analysis of the National Health Interview Survey was conducted to identify patients who reported a fracture within 3 months before survey completion. The National Health Interview Survey is an annual serial, cross-sectional survey administered by the United States Centers for Disease Control, involving approximately 90,000 individuals across 35,000 American households. The survey is designed to be generalizable to the civilian, noninstitutionalized United States population and is therefore well suited to evaluate longitudinal trends in physical, economic, and psychosocial health factors nationwide. We analyzed data from 2011 to 2017 and identified 1399 individuals who reported sustaining a fracture during the 3 months preceding their survey response. Among these patients, 27% (384 of 1399) were older than 65 years, 77% (1074) were White, 57% (796) were women, and 14% (191) were uninsured. A raw score compiled from 10 food security questions developed by the United States Department of Agriculture was used to determine the odds of 30-day food insecurity for each patient. A multivariate logistic regression analysis was performed to determine factors associated with food insecurity among patients reporting fractures . In the overall sample of National Health Interview Survey respondents, approximately 0.6% (1399 of 239,168) reported a fracture. RESULTS Overall, 17% (241 of 1399) of individuals reporting broken bones or fractures in the National Health Interview Survey also reported food insecurity. Individuals reporting fractures were more likely to report food insecurity if they also were aged between 45 and 64 years (adjusted odds ratio 4.0 [95% confidence interval 2.1 to 7.6]; p < 0.001), had a household income below USD 49,716 (200% of the federal poverty level) per year (adjusted OR 3.1 [95% CI 1.9 to 5.1]; p < 0.001), were current tobacco smokers (adjusted OR 2.8 [95% CI 1.6 to 5.1]; p < 0.001), and were of Black race (adjusted OR 1.9 [95% CI 1.1 to 3.4]; p = 0.02). CONCLUSION Among patients with fractures, food insecurity screening and routine nutritional assessments may help to direct financially vulnerable patients toward available community resources. Such screening programs may improve adherence to nutritional recommendations in the trauma recovery period and improve the physiologic environment for adequate soft tissue and bone healing. Future research may benefit from the inclusion of clinical nutritional data, a broader representation of high-energy injuries, and a prospective study design to evaluate cost-efficient avenues for food insecurity interventions in the context of locally available social services networks. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Tarun K. Jella
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Thomas B. Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Victoria S. Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Taylor M. Yong
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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Peng Ng B, Stewart MP, Kwon S, Hawkins GT, Park C. Dissatisfaction of Out-of-Pocket Costs and Problems Paying Medical Bills Among Medicare Beneficiaries With Type 2 Diabetes. Sci Diabetes Self Manag Care 2023; 49:126-135. [PMID: 36971086 DOI: 10.1177/26350106231163516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Purpose The purpose of the study was to examine the relationship between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills among Medicare beneficiaries with type 2 diabetes. Methods The 2019 Medicare Current Beneficiary Survey Public Use File, a nationally representative sample of Medicare beneficiaries aged ≥65 years with type 2 diabetes, was analyzed (n = 2178). A survey-weighted multivariable logit regression model was conducted to examine the association between satisfaction of Medicare coverage for out-of-pocket costs and problems paying medical bills, adjusted for sociodemographics and comorbidities. Results Among study beneficiaries, 12.6% reported problems paying medical bills. Among those with and without problems paying medical bills, 59.5% and 12.8%, respectively, were dissatisfied with out-of-pocket costs. In the multivariable analysis, beneficiaries who were dissatisfied with out-of-pocket costs were more likely to report problems paying medical bills than those who were satisfied. Younger beneficiaries, beneficiaries with lower incomes, those with functional limitations, and those with multiple comorbidities were more likely to report problems paying medical bills. Conclusions Despite having health care coverage, more than one-tenth of Medicare beneficiaries with type 2 diabetes reported problems paying medical bills, which raises concerns about delaying or forgoing needed medical care due to unaffordability. Screenings and targeted interventions that identify and reduce financial hardships associated with out-of-pocket costs should be prioritized.
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Affiliation(s)
- Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, Florida
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida
| | - Morgan P Stewart
- College of Pharmacy, The University of Texas at Austin, Austin, Texas
| | - Seoyon Kwon
- Department of Statistics and Data Science, University of Central Florida, Orlando, Florida
| | | | - Chanhyun Park
- College of Pharmacy, The University of Texas at Austin, Austin, Texas
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Johnson ER. Healthcare Access and Contraceptive Use among Adult Women in the United States in 2017. Contraception 2022; 110:30-35. [DOI: 10.1016/j.contraception.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
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Becot FA, Inwood SM. Medical economic vulnerability: a next step in expanding the farm resilience scholarship. AGRICULTURE AND HUMAN VALUES 2022; 39:1097-1116. [PMID: 35999960 PMCID: PMC9388717 DOI: 10.1007/s10460-022-10307-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 06/15/2023]
Abstract
In recent years, the long-standing questions of why, how, and which farm families continue farming in the face of ongoing changes have increasingly been studied through the resilience lens. While this body of work is providing updated and novel insights, two limitations, a focus on macro-level challenges faced by the farm operation and a mismatch between the scale of challenges and resilience measures, likely limit our understanding of the factors at play. We use the example of medical economic vulnerability, a micro-level challenge traditionally confined to the household sphere of the agri-family system, as a way to call attention to these limitations. Focusing on United States (U.S.) farm households, we assess: (1) To what extent are they experiencing medical economic vulnerability when using objective and subjective outcome measures? (2) Which demographic and farm characteristics are associated with experiencing medical economic vulnerability? (3) What is the association between institutional arrangements and medical economic vulnerability? Our analysis of over 900 surveys coupled with a conceptual framework merging complementary insights from three bodies of literature revealed seemingly large differences in the prevalence of medical economic vulnerability across the objective and subjective measures with the subjective measure indicating a general sentiment of medical economic vulnerability in a majority of respondents. Conversely, limited variations were noted in who experiences medical vulnerability on the basis of demographic and farm characteristics, with stronger associations being connected to the households' health insurance arrangements. We conclude with three implications of our findings for the farm resilience literature.
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Affiliation(s)
- Florence A. Becot
- National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI 54449 USA
| | - Shoshanah M. Inwood
- School of Environment and Natural Resources, The Ohio State University, 132 Williams Hall, 1680 Madison Avenue, Wooster, OH 44691 USA
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Jalilian H, Heydari S, Mir N, Fehresti S, Khodayari-Zarnaq R. Forgone care in patients with type 2 diabetes: a cross-sectional study. BMC Public Health 2021; 21:1588. [PMID: 34429093 PMCID: PMC8386068 DOI: 10.1186/s12889-021-11639-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Diabetes mellitus is a complex chronic disease requiring appropriate continuous medical care and delayed, or forgone care may exacerbate the severity of the disease. This study aimed to investigate the factors affecting forgone care in patients with type2 diabetes. MATERIALS AND METHODS This was a cross-sectional study involving 1139 patients with type 2 diabetes aged> 18 years in 2019 in Tabriz, Iran. The researcher-made questionnaire was used for data collection. Data were analyzed using IBM SPSS software version 22 and IBM AMOS 22. Exploratory Factor Analysis (EFA) was performed for dimension reduction of the questionnaire, and Confirmatory Factor Analysis (CFA) used to verify the result of EFA. We applied the binary logistic regression model to assess the factors affecting forgone care. RESULTS Of the 1139 patients, 510 patients (45%) reported forgone care during the last year. The percentage of forgoing care was higher in patients without supplementary insurance coverage (P = 0.01), those with complications (P = 0.01) and those with a history of hospitalization (P = 0.006). The majority of patients (41.5%) reported that the most important reason for forgoing care is financial barriers resulting from disease treatment costs. Of the main four factors affecting, quality of care had the highest impact on forgone care at 61.28 (of 100), followed by accessibility (37.01 of 100), awareness and attitude towards disease (18.52 of 100) and social support (17.22 of 100). CONCLUSION The results showed that, despite the implementation of the Islamic Republic of Iran on a fast-track to beating non-communicable diseases (IraPEN), a considerable number of patients with type2 diabetes had a history of forgoing care, and the most important reasons for forgoing care were related to the financial pressure and dissatisfaction with the quality of care. Therefore, not only more financial support programs should be carried out, but the quality of care should be improved.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Somayeh Heydari
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Mir
- Student Research Committee, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Fehresti
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population. JACC-HEART FAILURE 2021; 9:710-719. [PMID: 34391737 DOI: 10.1016/j.jchf.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to describe the prevalence of patients with forgone/delayed care for heart failure (HF) and examine the associated demographic characteristics, health care utilization, and costs. BACKGROUND HF is a leading cause of morbidity and mortality, with health care expenditures projected to increase 3-fold from 2012 to 2030. The proportion of HF patients with forgone/delayed medical care and the association with health care expenditures and utilization remain unknown. METHODS Data on patients with HF were obtained from the Medical Expenditure Panel Survey to assess expenditures and health care utilization in the United States from 2004 to 2015. Patients with HF who reported forgone/delayed care, any missed or delayed medical treatment, were compared with those without care lapses. RESULTS Overall, 16% of patients with HF reported forgone/delayed care, including 10% among the elderly (aged ≥65 years) and 27% among the nonelderly (age <65 years). Patients with HF who reported forgone/delayed care had annual health care expenses $8,027 (95% CI: $1,181-$14,872) higher than those who did not. Among the elderly, those reporting forgone/delayed care had more emergency department visits (43% vs 58%; P < 0.05), and had higher annual inpatient costs (+$7,548; 95% CI: $1,109-$13,988) and total health care costs (+$10,581; 95% CI: $1,754-$19,409). Sixty percent of nonelderly and 46% of elderly patients with HF reported deferring care due to financial barriers. CONCLUSIONS Nearly 1 in 6 patients with HF in the United States reported forgone/delayed medical care, with one-half attributing it to financial reasons, and this was associated with higher overall health care spending.
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Walter AW, Ellis RP, Yuan Y. Health care utilization and spending among privately insured children with medical complexity. J Child Health Care 2019; 23:213-231. [PMID: 30025469 DOI: 10.1177/1367493518785778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children with medical complexity have high health service utilization and health expenditures that can impose significant financial burdens. This study examined these issues for families with children enrolled in US private health plans. Using IBM Watson/Truven Analytics℠ MarketScan® commercial claims and encounters data (2012-2014), we analyzed through regression models, the differences in health care utilization and spending of disaggregated health care services by health plan types and children's medical complexity levels. Children in consumer-driven and high-deductible plans had much higher out-of-pocket spending and cost shares than those in health maintenance organizations and preferred provider organizations (PPOs). Children with complex chronic conditions had higher service utilization and out-of-pocket expenditures while having lower cost shares on various categories of services than those without any chronic condition. Compared to families covered by PPOs, those with high-deductible or consumer-driven plans were 2.7 and 1.7 times more likely to spend over US$1000 out of pocket on their children's medical care, respectively. Families with higher complexity levels were more likely to experience financial burdens from expenditures on children's medical services. In conclusion, policymakers and families with children need to be cognizant of the significant financial burdens that can arise from children's complex medical needs and health plan demand-side cost sharing.
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Affiliation(s)
- Angela Wangari Walter
- 1 Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Randall P Ellis
- 2 Department of Economics, Boston University, Boston, MA, USA
| | - Yiyang Yuan
- 3 Department of Quantitative Health Sciences, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Jiang J, Chen S, Xin Y, Wang X, Zeng L, Zhong Z, Xiang L. Does the critical illness insurance reduce patients' financial burden and benefit the poor more: a comprehensive evaluation in rural area of China. J Med Econ 2019; 22:455-463. [PMID: 30744446 DOI: 10.1080/13696998.2019.1581620] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Critical illness insurance (CII) is one kind of health insurance that is gradually gaining attention worldwide. China implemented CII in 2012 to decrease patients' out-of-pocket (OOP) medical payments. The aims of this study were to determine if the project had positive impacts on relieving financial burden and improving health equity. METHODS A series of questionnaire surveys were undertaken in two counties before and after the intervention in rural China. OOP expenditure, catastrophic Health Expenditure (CHE) incidence, and associated average gap (AG) were assessed across different income groups and project durations, measuring short-term direct medical cost. Medical debt rate and amount were used to measure long-term financial burden; concentration index (CI) was calculated for equity. All data were evaluated by descriptive statistics and multi-variate variance analysis. The linear regression and logit regression with random effect analysis upon area was used to evaluate the effect of CII. RESULTS Six hundred and thirteen and 834 patients were surveyed at baseline and final evaluation. After the program, the OOP payments of hospitalizations sharply decreased from RMB 39,363.2 to RMB 28,426.1 (p < 0.001), with the largest decrease for lowest income patients (from RMB 44,507.6 to RMB 29,214.2). With longer duration of CII, more OOP medical payments decreased. The amount of medical debt was decreased by RMB 7,209.4 among all the patients, and the decrease was highest in the highest income group (RMB 8,119.9). The CI of AG changed a lot (from -0.858 to -0.670). CONCLUSION The CII has effectively reduced the financial burden of patients with high medical cost, whether in the short-term or a longer length of time. It also improved health equity in health service utilization and expenditure. However, rich householders still receive more benefits from the policy, government health insurance financing is increased, and the policy needs to further benefit the poor.
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Affiliation(s)
- Junnan Jiang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Shanquan Chen
- b Jockey Club School of Public Health and Primary Care , Chinese University of Hong Kong , Hong Kong , China
| | - Yanjiao Xin
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Xuefeng Wang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Li Zeng
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Zhengdong Zhong
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Li Xiang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
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Panczak R, von Wyl V, Reich O, Luta X, Maessen M, Stuck AE, Berlin C, Schmidlin K, Goodman DC, Egger M, Clough-Gorr K, Zwahlen M. Death at no cost? Persons with no health insurance claims in the last year of life in Switzerland. BMC Health Serv Res 2018. [PMID: 29540161 PMCID: PMC5853076 DOI: 10.1186/s12913-018-2984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Lack of health insurance claims (HIC) in the last year of life might indicate suboptimal end-of-life care, but reasons for no HIC are not fully understood because information on causes of death is often missing. We investigated association of no HIC with characteristics of individuals and their place of residence. Methods We analysed HIC of persons who died between 2008 and 2010, which were obtained from six providers of mandatory Swiss health insurance. We probabilistically linked these persons to death certificates to get cause of death information and analysed data using sex-stratified, multivariable logistic regression. Supplementary analyses looked at selected subgroups of persons according to the primary cause of death. Results The study population included 113,277 persons (46% males). Among these persons, 1199 (proportion 0.022, 95% CI: 0.021–0.024) males and 803 (0.013, 95% CI: 0.012–0.014) females had no HIC during the last year of life. We found sociodemographic and health differentials in the lack of HIC at the last year of life among these 2002 persons. The likelihood of having no HIC decreased steeply with older age. Those who died of cancer were more likely to have HIC (adjusted odds ratio for males 0.17, 95% CI: 0.13–0.22; females 0.19, 95% CI: 0.12–0.28) whereas those dying of mental and behavioural disorders (AOR males 1.83, 95% CI:1.42–2.37; females 1.65, 95% CI: 1.27–2.14), and males dying of suicide (AOR 2.15, 95% CI: 1.72–2.69) and accidents (AOR 2.41, 95% CI: 1.96–2.97) were more likely to have none. Single, widowed, and divorced persons also were more likely to have no HIC (AORs in range of 1.29–1.80). There was little or no association between the lack of HIC and characteristics of region of residence. Patterns of no HIC differed across main causes of death. Associations with age and civil status differed in particular for persons who died of cancer, suicide, accidents and assaults, and mental and behavioural disorders. Conclusions Particular groups might be more likely to not seek care or not report health insurance costs to insurers. Researchers should be aware of this aspect of health insurance data and account for persons who lack HIC. Electronic supplementary material The online version of this article (10.1186/s12913-018-2984-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
| | - Viktor von Wyl
- Epidemiology, Biostatistics & Prevention Institute, University of Zürich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Palmstrasse 26b, 8401, Winterthur, Switzerland.,SWICA Gesunheitsorganisation, sante24, Winterthur, Switzerland
| | - Xhyljeta Luta
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Maud Maessen
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,University Center for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 28, 3010, Bern, Switzerland
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,The Dartmouth Institute of Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Kerri Clough-Gorr
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,Section of Geriatrics, Boston University Medical Center, Boston, MA, USA
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
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Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. Lancet 2017; 389:1431-1441. [PMID: 28402825 DOI: 10.1016/s0140-6736(17)30398-7] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/19/2016] [Accepted: 01/06/2017] [Indexed: 11/29/2022]
Abstract
Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. Other articles in this Series address population health inequalities, and the health effects of racism, mass incarceration, and the Affordable Care Act (ACA). Poor Americans have worse access to care than do wealthy Americans, partly because many remain uninsured despite coverage expansions since 2010 due to the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health-care resources devoted to care of the wealthy has risen. Additional reforms that move forward, rather than backward, from the ACA are sorely needed to mitigate health and health-care inequalities and reduce the financial burdens of medical care borne by non-wealthy Americans.
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Affiliation(s)
- Samuel L Dickman
- Department of Medicine, University of California, San Francisco, CA, USA
| | - David U Himmelstein
- City University of New York School of Urban Public Health at Hunter College, New York, NY, USA; Harvard Medical School, Boston, MA, USA.
| | - Steffie Woolhandler
- City University of New York School of Urban Public Health at Hunter College, New York, NY, USA; Harvard Medical School, Boston, MA, USA
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Röttger J, Blümel M, Köppen J, Busse R. Forgone care among chronically ill patients in Germany-Results from a cross-sectional survey with 15,565 individuals. Health Policy 2016; 120:170-8. [PMID: 26806678 DOI: 10.1016/j.healthpol.2016.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/27/2015] [Accepted: 01/03/2016] [Indexed: 01/09/2023]
Abstract
The decision not to seek health care although one feels that care is needed (forgone care), is influenced by various factors. Within the study "Responsiveness in ambulatory care" 15,565 chronically ill (coronary heart disease and/or type 2 diabetes) patients in Germany were surveyed in 2013. The survey included questions on forgone care, perceived discrimination when seeking care, net-income, subjective health status and subjective socioeconomic status (subSES). Survey data were linked on patient-level with administrative claims data by a German sickness fund. We applied multivariate binomial logistic regression analyses to assess the association between age, sex, comorbidities, living area, subjective health status, subSES, experienced discrimination, net-equivalent income and reported forgone care. The majority in the sample are men (71.4%), the average age is 69.4 (SD: 10.2) years and 14.1% reported forgone care. In the multivariate model, we find that younger age, female gender, perceived discrimination, depression, and a poor subjective health status increase the odds of reporting forgone care. Overall, our results suggest that a negative experience with the health care system, i.e. perceived discrimination/unfair treatment, are strong predictors of forgone care among the chronically ill.
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Affiliation(s)
- Julia Röttger
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany.
| | - Miriam Blümel
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Julia Köppen
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Reinhard Busse
- Berlin Centre for Health Economics Research, Department of Health Care Management, Berlin University of Technology, Strasse des 17. Juni 135, 10623 Berlin, Germany
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