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Ufere NN, Serper M, Kaplan A, Horick N, Indriolo T, Li L, Satapathy N, Donlan J, Castano Jimenez JC, Lago-Hernandez C, Lieber S, Gonzalez C, Keegan E, Schoener K, Bethea E, Dageforde LA, Yeh H, El-Jawahri A, Park ER, Vodkin I, Schonfeld E, Nipp R, Desai A, Lai JC. Financial burden following adult liver transplantation is common and associated with adverse recipient outcomes. Liver Transpl 2024:01445473-990000000-00333. [PMID: 38353602 DOI: 10.1097/lvt.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The financial impact of liver transplantation has been underexplored. We aimed to identify associations between high financial burden (≥10% annual income spent on out-of-pocket medical costs) and work productivity, financial distress (coping behaviors in response to the financial burden), and financial toxicity (health-related quality of life, HRQOL) among adult recipients of liver transplant. Between June 2021 and May 2022, we surveyed 207 adult recipients of liver transplant across 5 US transplant centers. Financial burden and distress were measured by 25 items adapted from national surveys of cancer survivors. Participants also completed the Work Productivity and Activity Impairment and EQ-5D-5L HRQOL questionnaires. In total, 23% of recipients reported high financial burden which was significantly associated with higher daily activity impairment (32.9% vs. 23.3%, p =0.048). In adjusted analyses, the high financial burden was significantly and independently associated with delayed or foregone medical care (adjusted odds ratio, 3.95; 95% CI, 1.85-8.42) and being unable to afford basic necessities (adjusted odds ratio, 5.12; 95% CI: 1.61-16.37). Recipients experiencing high financial burden had significantly lower self-reported HRQOL as measured by the EQ-5D-5L compared to recipients with low financial burden (67.8 vs. 76.1, p =0.008) and an age-matched and sex-matched US general population (67.8 vs. 79.1, p <0.001). In this multicenter cohort study, nearly 1 in 4 adult recipients of liver transplant experienced a high financial burden, which was significantly associated with delayed or foregone medical care and lower self-reported HRQOL. These findings underscore the need to evaluate and address the financial burden in this population before and after transplantation.
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Affiliation(s)
- Nneka N Ufere
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alyson Kaplan
- Department of Medicine, Tufts Abdominal Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Nora Horick
- Department of Statistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Teresa Indriolo
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucinda Li
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nishant Satapathy
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - John Donlan
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janeth C Castano Jimenez
- Department of Medicine, Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carlos Lago-Hernandez
- Department of Medicine, Division of Hospital Medicine, University of California San Diego, La Jolla, California, USA
| | - Sarah Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Carolina Gonzalez
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eileen Keegan
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly Schoener
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily Bethea
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leigh-Anne Dageforde
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Heidi Yeh
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Mongan Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Irine Vodkin
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, California, USA
| | - Emily Schonfeld
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Archita Desai
- Department of Medicine, Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jennifer C Lai
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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Jackson H, Keisler-Starkey K. Out-of-Pocket Medical Expenditures in the Redesigned Current Population Survey: Evaluating Improvements to Data Processing. Med Care Res Rev 2023; 80:548-557. [PMID: 37178015 PMCID: PMC10524916 DOI: 10.1177/10775587231170951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Household surveys are an important source of information on medical spending and burden. We examine how recently implemented post-processing improvements to the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) affected estimates of medical expenditures and medical burden. The revised data extraction and imputation procedures mark the second stage of the CPS ASEC redesign and the beginning of a new time series for studying household medical expenditures. Using data for the calendar year 2017, we find that median family medical expenditures are not statistically different from legacy methods; however, updated processing does significantly reduce the percentage of families estimated to have a high medical burden (medical expenses are at least 10% of family income). The updated processing system also changes the characteristics of families with high medical spending and is primarily driven by changes in imputation of health insurance and medical spending.
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Bhatia S, Dai C, Hageman L, Wu J, Schlichting E, Siler A, Funk E, Hicks J, Lim S, Balas N, Bosworth A, Te HS, Francisco L, Bhatia R, Forman SJ, Wong FL, Arora M, Armenian SH, Weisdorf DJ, Landier W. Financial Burden in Blood or Marrow Transplantation Survivors During the COVID-19 Pandemic: A BMTSS Report. J Clin Oncol 2023; 41:1011-1022. [PMID: 36455192 PMCID: PMC9928670 DOI: 10.1200/jco.22.00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/05/2022] [Accepted: 10/20/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The financial burden experienced by blood or marrow transplant (BMT) survivors during the COVID-19 pandemic remains unstudied. We evaluated the risk for high out-of-pocket medical costs and associated financial burden experienced by BMT survivors and a sibling comparison group during the COVID-19 pandemic. METHODS This study included 2,370 BMT survivors and 750 siblings who completed the BMT Survivor Study survey during the pandemic. Participants reported employment status, out-of-pocket medical costs, and financial burden. Medical expenses ≥ 10% of the annual household income constituted high out-of-pocket medical costs. Logistic regression identified factors associated with high out-of-pocket medical costs and financial burden. RESULTS BMT survivors were more likely to incur high out-of-pocket medical costs (11.3% v 3.1%; adjusted odds ratio [aOR], 2.88; 95% CI, 1.84 to 4.50) than the siblings. Survivor characteristics associated with high out-of-pocket medical costs included younger age at study (aORper_year_younger_age, 1.02; 95% CI, 1.00 to 1.03), lower prepandemic annual household income and/or education (< $50,000 US dollars and/or < college graduate: aOR, 1.96; 95% CI, 1.42 to 2.69; reference: ≥ $50,000 in US dollars and ≥ college graduate), > 1 chronic health condition (aOR, 2.82; 95% CI, 2.00 to 3.98), ≥ 1 hospitalization during the pandemic (aOR, 2.11; 95% CI, 1.53 to 2.89), and being unemployed during the pandemic (aOR, 1.52; 95% CI, 1.06 to 2.17). Among BMT survivors, high out-of-pocket medical costs were significantly associated with problems in paying medical bills (aOR, 10.57; 95% CI, 7.39 to 15.11), deferring medical care (aOR, 4.93; 95% CI, 3.71 to 6.55), taking a smaller dose of medication than prescribed (aOR, 4.99; 95% CI, 3.23 to 7.70), and considering filing for bankruptcy (aOR, 3.80; 95% CI, 2.14 to 6.73). CONCLUSION BMT survivors report high out-of-pocket medical costs, which jeopardizes their health care and may affect health outcomes. Policies aimed at reducing financial burden in BMT survivors, such as expanding access to patient assistance programs, may mitigate the negative health consequences.
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Affiliation(s)
- Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Wu
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth Schlichting
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Arianna Siler
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Erin Funk
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Jessica Hicks
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Shawn Lim
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Nora Balas
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | | | - Hok Sreng Te
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Ravi Bhatia
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | - Stephen J. Forman
- Division of Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL
| | | | - Mukta Arora
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Daniel J. Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL
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Creedon TB, Zuvekas SH, Hill SC, Ali MM, McClellan C, Dey JG. Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid. Health Serv Res 2022; 57 Suppl 2:183-194. [PMID: 35811358 PMCID: PMC9660429 DOI: 10.1111/1475-6773.14034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To estimate the effects of Affordable Care Act (ACA) Medicaid expansion on insurance and health services use for adults with disabilities who were newly eligible for Medicaid. DATA SOURCES 2008-2018 Medical Expenditure Panel Survey data. STUDY DESIGN We used the Agency for Healthcare Research and Quality (AHRQ) PUBSIM model to identify adults aged 26-64 years with disabilities who were newly Medicaid-eligible in expansion states or would have been eligible in non-expansion states had those states opted to expand. Outcomes included insurance coverage; access to care; receipt of primary care, outpatient specialty physician services, and preventive services; and out-of-pocket health care spending. To estimate the effects of Medicaid expansion, we used two-way fixed effects models and a triple differences framework to compare pre-post changes in each outcome in expansion and non-expansion states for adults with and without disabilities. EXTRACTION METHODS We simulated Medicaid eligibility with the AHRQ PUBSIM model, which uses state-specific Medicaid rules and MEPS data on family relationships, state of residence, and income. PRINCIPAL FINDINGS Among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with significant increases in full-year Medicaid coverage (35.9 percentage points [pp], p < 0.001), receipt of primary care (15.5 pp, p < 0.01), and receipt of flu shots (19.2 pp, p < 0.01), and a significant decrease in out-of-pocket spending (-$457, p < 0.01). There were larger improvements for adults with disabilities compared to those without disabilities in full-year Medicaid coverage (11.0 pp, p < 0.01) and receipt of flu shots (18.0 pp, p < 0.05). CONCLUSIONS Medicaid expansion was associated with improvements in full-year insurance coverage, receipt of primary and preventive care, and out-of-pocket spending for adults with disabilities who were newly eligible for Medicaid. For insurance coverage, preventive care, and some primary care measures, there were differentially larger improvements for adults with disabilities than for those without disabilities.
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Affiliation(s)
- Timothy B. Creedon
- Office of the Assistant Secretary for Planning and EvaluationUS Department of Health and Human ServicesWashingtonDistrict of ColumbiaUSA
| | - Samuel H. Zuvekas
- Agency for Healthcare Research and QualityUS Department of Health and Human ServicesRockvilleMarylandUSA
| | - Steven C. Hill
- Agency for Healthcare Research and QualityUS Department of Health and Human ServicesRockvilleMarylandUSA
| | - Mir M. Ali
- Office of the Assistant Secretary for Planning and EvaluationUS Department of Health and Human ServicesWashingtonDistrict of ColumbiaUSA
| | - Chandler McClellan
- Agency for Healthcare Research and QualityUS Department of Health and Human ServicesRockvilleMarylandUSA
| | - Judith G. Dey
- Office of the Assistant Secretary for Planning and EvaluationUS Department of Health and Human ServicesWashingtonDistrict of ColumbiaUSA
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Lee C. Is Universal Health Insurance Superior in Terms of Healthcare Payment? Estimating Financial Burden of Healthcare in Korea: 2009 to 2019. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221135957. [PMID: 36346007 PMCID: PMC9647288 DOI: 10.1177/00469580221135957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study estimates the financial burden of healthcare in Korea using the National Survey of Tax and Benefit panel data from 2009 to 2019. The sum of a household’s premium and out-of-pocket medical expenses defines the household financial burden of healthcare. We find that the household financial burden is regressive to income. We also find that the high burden household whose financial burden is over 10% of their household income accounts for about 30% of total household. This result suggests that equity in contribution to healthcare finance does not work well in Korea, which chose the universal health system that emphasizes the progressive contribution by income to medical finance.
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Jacobs PD, Hill SC. ACA Marketplaces Became Less Affordable Over Time For Many Middle-Class Families, Especially The Near-Elderly. Health Aff (Millwood) 2021; 40:1713-1721. [PMID: 34724430 DOI: 10.1377/hlthaff.2021.00945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act provides tax credits for Marketplace insurance, but before 2021, families with incomes above four times the federal poverty level did not qualify for tax credits and could face substantial financial burdens when purchasing coverage. As a measure of affordability, we calculated potential Marketplace premiums as a percentage of family income among families with incomes of 401-600 percent of poverty. In 2015 half of this middle-class population would have paid at least 7.7 percent of their income for the lowest-cost bronze plan; in 2019 they would have paid at least 11.3 percent of their income. By 2019 half of the near-elderly ages 55-64 would have paid at least 18.9 percent of their income for the lowest-cost bronze plan in their area. The American Rescue Plan Act temporarily expanded tax credit eligibility for 2021 and 2022, but our results suggest that families with incomes of 401-600 percent of poverty will again face substantial financial burdens after the temporary subsidies expire.
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Affiliation(s)
- Paul D Jacobs
- Paul D. Jacobs is a mathematical statistician in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Steven C Hill
- Steven C. Hill is a senior economist in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality
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9
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Coughlin SS, Datta B, Berman A, Hatzigeorgiou C. A cross-sectional study of financial distress in persons with multimorbidity. Prev Med Rep 2021; 23:101464. [PMID: 34258176 PMCID: PMC8254038 DOI: 10.1016/j.pmedr.2021.101464] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Financial distress among persons with multimorbidity is an important topic which has been inadequately addressed to date. OBJECTIVE We examined the extent of financial distress among persons with multimorbidity, using data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). DESIGN Cross-sectional, population-based study. PARTICIPANTS Adults ages ≥ 18 years with multimorbidity. MAIN MEASURES Low income and selected social determinants of health that are indicators of financial distress. KEY RESULTS Multimorbidity was more common among those with a household income of less than $15,000 per year (P < 0.001) and among those who were 65 years of age or older (P < 0.001). There was an approximately linear increase in the percentage of individuals who had a household income of less than $15,000 or $25,000 per year with increasing number of morbidities. About one-quarter of individuals who had five or more morbidities had a household income of less than $15,000 per year as compared with 4.49% of individuals with no morbidities (P < 0.001). For all of the social determinants of health examined (Couldn't pay bills, didn't have money for food, didn't have money for balanced meals, didn't have enough money to make ends meet, and felt this kind of stress), there was an approximately linear increase in the percentage of individuals with an indicator of financial distress with increasing number of morbidities. Further research is needed examining the prevalence and correlates of financial distress in this population as well effective strategies for ameliorating its impact on the health and wellbeing of these persons.
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Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Augusta University, 1120 15 Street, Augusta, GA 30912, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Biplab Datta
- Department of Population Health Sciences, Augusta University, 1120 15 Street, Augusta, GA 30912, USA
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Adam Berman
- Department of Population Health Sciences, Augusta University, 1120 15 Street, Augusta, GA 30912, USA
- Division of Cardiology, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Christos Hatzigeorgiou
- Division of General Internal Medicine, Augusta University, 1120 15 Street, Augusta, GA 30912, USA
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Shumet Y, Mohammed SA, Kahissay MH, Demeke B. Catastrophic Health Expenditure among Chronic Patients Attending Dessie Referral Hospital, Northeast Ethiopia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:99-107. [PMID: 33568923 PMCID: PMC7868221 DOI: 10.2147/ceor.s291463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Catastrophic health expenditure is health spending that is not covered by a health-care plan. These costs tend to escalate over time, due to chronic illnesses. Catastrophic health expenditure leads to decreased use of health services and poorer treatment outcomes. This study measured the extent of and factors associated with catastrophic health expenditure among chronically ill patients attending Dessie Referral Hospital in northeast Ethiopia. METHODS An institution-based cross-sectional study design was used to quantify catastrophic health expenditure among 302 chronically ill patients from May 25, 2018 to June 30, 2018. A stratified sampling technique was used to select the study participants. Descriptive and inferential statistics were computed using SPSS 20. RESULTS Catastrophic health expenditure was found in 194 (64.2%, 95% CI 58.8%-70.5%) of chronic patients. Costly service (151, 50%), transport (104, 34.4%), and pharmaceuticals (189, 62.6%) were the reasons for catastrophic health expenditure among chronic patients. Factors associated with catastrophic health expenditure were age <30 years (AOR 7.74, CI 0.94-63.62; P=0.01), patient monthly income CONCLUSION Two-thirds of chronic patients had catastrophic health expenditure. Starting and strengthening various health-insurance schemes will make chronic-care services more accessible and affordable.
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Affiliation(s)
- Yohannes Shumet
- Department of Pharmacy, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Ahmed Mohammed
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mesfin Haile Kahissay
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Birhanu Demeke
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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11
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Mercadante S, Aielli F, Adile C, Bonanno G, Casuccio A. Financial distress and its impact on symptom expression in advanced cancer patients. Support Care Cancer 2020; 29:485-490. [DOI: 10.1007/s00520-020-05507-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022]
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Tsuchiya K, Leung CW, Jones AD, Caldwell CH. Multiple financial stressors and serious psychological distress among adults in the USA. Int J Public Health 2020; 65:335-344. [PMID: 32239257 DOI: 10.1007/s00038-020-01354-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 02/09/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Financial stress has adverse consequences for health. However, the association between individual and cumulative associations of multiple financial stressors and serious psychological distress (SPD) is unclear. METHODS Using data from the 2017 National Health Interview Survey, we examined cross-sectional associations between perceived financial worries, healthcare insecurity, food insecurity, and SPD among 23,317 US adults. Associations were examined using logistic regression. RESULTS Among US adults in 2017, the overall prevalence of SPD was 3.6%. Among those with SPD, 85.5% were financially worried, 50.3% were food insecure, and 51.2% were healthcare insecure. Financial worries (OR 4.27; CI 3.31, 5.52), food insecurity (OR 2.34; CI 1.92, 2.85), and healthcare insecurity (OR 2.26; CI 1.85, 2.76) were each associated with higher odds of SPD. A dose-response association was found between the number of stressors and SPD. CONCLUSIONS Each financial stressor was adversely associated with SPD both individually and cumulatively, indicating the adverse effects of the accumulation of these stressors. Additional studies are needed to understand the longitudinal effects of multiple financial stressors on mental health outcomes.
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Affiliation(s)
- Kazumi Tsuchiya
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA.
| | - Cindy W Leung
- Department of Nutritional Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, MI, USA
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13
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Abstract
Background We examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Methods and Results The participants were aged 18 to 64 years from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) for 2010-2015. High burden is out-of-pocket spending on care and insurance premiums >20% of income. Barriers to care are forgoing and delaying care for financial reasons. Logistic regressions were used to estimate the odds of having high burdens and barriers. Adults treated for heart disease have odds ratios (ORs) of 2.18 (95% CI, 1.91-2.50) for having high burden, 2.51 (95% CI, 2.23-2.83) for forgoing care, and 3.57 (95% CI, 3.8-4.13) for delaying care compared with adults without any chronic condition. Among adults treated for heart disease compared with adults with private group coverage, ORs for having high burdens were significantly lower among those with public insurance (OR: 0.17; 95% CI, 0.10-0.26) or the uninsured (OR: 0.58; 95% CI, 0.36-0.92) and higher among those with private nongroup insurance (OR: 5.30; 95% CI, 3.26-8.61). Compared with adults with private group coverage, ORs for delaying care were 2.07 (95% CI, 1.37-3.12) for those with public insurance, 2.64; 95% CI, 1.70-4.10) for those without insurance, and 2.16 (95% CI, 1.24-3.76) for those with private nongroup insurance. Conclusions Public insurance provides protection against high burdens but not against forgoing or delaying care. Future research should investigate whether and to what extent barriers to care are associated with worse health outcomes and higher costs in the long term.
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Affiliation(s)
- Didem Bernard
- Agency for Healthcare Research and Quality (AHRQ) Rockville MD
| | - Zhengyi Fang
- Social & Scientific Systems, Inc. Silver Spring MD
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14
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Jacobs PD, Selden TM. Changes In The Equity Of US Health Care Financing In The Period 2005-16. Health Aff (Millwood) 2019; 38:1791-1800. [PMID: 31618081 DOI: 10.1377/hlthaff.2019.00625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spending on health care in the United States amounted to 17.9 percent of gross domestic product in 2017. Households paid for this care through out-of-pocket medical spending and a complex mix of out-of-pocket premiums, employer premium contributions, taxes, and subsidies that combined to finance private employer-sponsored insurance, nongroup insurance, and multiple public insurance programs. Our analysis examined the impact of this complex system of health care financing on households in the period 2005-16, tracking how economic and policy changes affected incidence-that is, the amount paid to finance health care, either directly or indirectly, by households as a share of their pretax income. Health care financing was regressive at the start of our study period, with households in the bottom 20 percent of income paying 26.8 percent of their income compared to about half that amount for those with income in the top 1 percent. By 2016 incidence had become approximately proportional (the same percentage across all income levels). In part, these results reflect increases in coverage through Medicaid and the Affordable Care Act Marketplaces, which are progressively financed through the federal tax system.
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Affiliation(s)
- Paul D Jacobs
- Paul D. Jacobs ( paul. jacobs@ahrq. hhs. gov ) is a senior fellow in the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland
| | - Thomas M Selden
- Thomas M. Selden is director of the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, AHRQ
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15
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Khera R, Valero-Elizondo J, Okunrintemi V, Saxena A, Das SR, de Lemos JA, Krumholz HM, Nasir K. Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States. JAMA Cardiol 2019; 3:729-738. [PMID: 29971325 DOI: 10.1001/jamacardio.2018.1813] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Health insurance is effective in preventing financial hardship from unexpected major health care events. However, it is also essential to assess whether vulnerable patients, particularly those from low-income families, are adequately protected from longitudinal health care costs for common chronic conditions such as atherosclerotic cardiovascular disease (ASCVD). Objective To examine the annual burden of total out-of-pocket health expenses among low-income families that included a member with ASCVD. Design, Setting, and Participants In this cross-sectional study of the Medical Expenditure Panel Survey from January 2006 through December 2015, all families with 1 or more members with ASCVD were identified. Families were classified as low income if they had an income under 200% of the federal poverty limit. Analyses began December 2017. Main Outcomes and Measures Total annual inflation-adjusted out-of-pocket expenses, inclusive of insurance premiums, for all patients with ASCVD. We compared these expenses against annual family incomes. Out-of-pocket expenses of more than 20% and more than 40% of family income defined high and catastrophic financial burden, respectively. Results We identified 22 521 adults with ASCVD, represented in 20 600 families in the Medical Expenditure Panel Survey. They correspond to an annual estimated 23 million or 9.9% of US adults with a mean (SE) age of 65 (0.2) years and included 10.9 million women (47.1%). They were represented in 21 million or 15% of US families. Of these, 8.2 million families (39%) were low income. The mean annual family income was $57 143 (95% CI, $55 377-$58 909), and the mean out-of-pocket expense was $4415 (95% CI, $3735-$3976). While financial burden from health expenses decreased throughout the study, even in 2014 and 2015, low-income families had 3-fold higher odds than mid/high-income families of high financial burden (21.4% vs 7.6%; OR, 3.31; 95% CI, 2.55-4.31) and 9-fold higher odds of catastrophic financial burden (9.8% vs 1.2%; OR, 9.35; 95% CI, 5.39-16.20), representing nearly 2 million low-income families nationally. Further, even among the insured, 1.6 million low-income families (21.8%) experienced high financial burden and 721 000 low-income families (9.8%) experienced catastrophic out-of-pocket health care expenses in 2014 and 2015. Conclusions and Relevance One in 4 low-income families with a member with ASCVD, including those with insurance coverage, experience a high financial burden, and 1 in 10 experience a catastrophic financial burden due to cumulative out-of-pocket health care expenses. To alleviate economic disparities, policy interventions must extend focus to improving not only access, but also quality of coverage, particularly for low-income families.
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Affiliation(s)
- Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Javier Valero-Elizondo
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami Beach
| | - Victor Okunrintemi
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami Beach
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami Beach
| | - Sandeep R Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Cheng P, Kalmbach DA, Tallent G, Joseph CL, Espie CA, Drake CL. Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep 2019; 42:zsz150. [PMID: 31535688 PMCID: PMC6783888 DOI: 10.1093/sleep/zsz150] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is a common precursor to depression; yet, the potential for insomnia treatment to prevent depression has not been demonstrated. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces concurrent symptoms of insomnia and depression and can be delivered digitally (dCBT-I); however, it remains unclear whether treating insomnia leads to sustained reduction and prevention of depression. This randomized controlled trial examined the efficacy of dCBT-I in reducing and preventing depression over a 1-year follow-up period. METHODS Patients with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia disorder were randomly assigned to receive dCBT-I or an attentional control. The follow-up sample included 358 patients in the dCBT-I condition and 300 patients in the online sleep education condition. The primary outcome measure was relative rate ratios for depression at 1-year follow-up. Insomnia responses to treatment were also tested as predictors of incident depression at the 1-year follow-up. RESULTS At 1-year follow-up, depression severity continued to be significantly lower in the dCBT-I condition relative to control. In addition, the number of individuals who reported no depression at 1-year follow-up was 51% higher in the dCBT-I condition relative to control. In those with minimal to no depression at baseline, the incident rate of moderate-to-severe depression at 1-year follow-up was reduced by half in the dCBT-I condition relative to the control condition. CONCLUSION dCBT-I showed robust effects as an intervention that prevents depression. Future research should examine dose-response requirements and further characterize mechanisms of action of dCBT-I for depression prevention. CLINICAL TRIAL Sleep to Prevent Evolving Affective Disorders; NCT02988375.
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Affiliation(s)
- Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| | - David A Kalmbach
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| | - Gabriel Tallent
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| | | | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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17
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Hill SC, Solomon KT, Maclean JC, Pesko MF. Effects of improvements in the CPS on the estimated prevalence of medical financial burdens. Health Serv Res 2019; 54:920-929. [PMID: 31032917 PMCID: PMC6606553 DOI: 10.1111/1475-6773.13158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To measure the effects of questionnaire and imputation improvements in the Current Population Survey (CPS) on the estimated prevalence of high medical financial burden, that is, families spending more than 10 percent of income on medical care. DATA SOURCE Matched longitudinal sample of CPS data for 2013 and 2014 calendar years. STUDY DESIGN The CPS used a split-sample design to field traditional and redesigned questions about 2013 income, and old and new out-of-pocket premium imputation procedures, respectively. For both samples, CPS data for 2014 were from the redesigned income questions and the new imputation procedures. We quantify the effects of the combined survey improvements using differences-in-differences methods. PRINCIPAL FINDINGS The improvements were not associated with changes in the estimate of burden in the full sample. Estimated prevalence increased by 2.6 percentage points among nonelderly adults with private insurance, decreased by 6.6 percentage points among nonelderly adults with public coverage, and decreased by 5.8 percentage points among elderly adults with Medicare and no private coverage. CONCLUSIONS Improvements in the CPS changed the estimated prevalence of high medical financial burden among key subgroups. Researchers should use caution when tracking burden across the time-period in which these improvements were implemented.
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Affiliation(s)
- Steven C. Hill
- Center for Financing, Access and Cost TrendsAgency for Healthcare Research and QualityRockvilleMaryland
| | | | - Johanna Catherine Maclean
- Department of EconomicsTemple UniversityPhiladelphiaPennsylvania
- National Bureau of EconomicsPhiladelphiaPennsylvania
- Institute for Labor EconomicsPhiladelphiaPennsylvania
| | - Michael F. Pesko
- Department of Economics Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaGeorgia
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18
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Zewde N, Wimer C. Antipoverty Impact Of Medicaid Growing With State Expansions Over Time. Health Aff (Millwood) 2019; 38:132-138. [DOI: 10.1377/hlthaff.2018.05155] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Naomi Zewde
- Naomi Zewde is a postdoctoral research scientist at the Center on Poverty and Social Policy, Columbia University School of Social Work, in New York City
| | - Christopher Wimer
- Christopher Wimer is codirector of the Center on Poverty and Social Policy, Columbia University School of Social Work
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Kwon E, Park S, McBride TD. Health Insurance and Poverty in Trajectories of Out-of-Pocket Expenditure among Low-Income Middle-Aged Adults. Health Serv Res 2018; 53:4332-4352. [PMID: 29770438 DOI: 10.1111/1475-6773.12974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To assess the effects of longitudinal patterns of health insurance and poverty on out-of-pocket expenditures among low-income late middle-aged adults. DATA SOURCES/STUDY SETTING Six waves (2002-2012) of the Health and Retirement Study, in combination with RAND Center for the Study of Aging data, were used. STUDY DESIGN A random coefficient regression analysis was conducted in a multilevel growth curve framework to estimate the impact of health insurance and poverty on out-of-pocket expenditures. PRINCIPAL FINDINGS At baseline, individuals with private insurance or unstable coverage were more likely to have out-of-pocket expenditures and financial burdens than public insurance holders. Over time, the poor who had no insurance, unstable coverage, or insurance type change had higher out-of-pocket expenditures; private coverage holders had higher odds of financial burden. CONCLUSIONS Unstable insurance coverage had a discernible effect on the long-term, out-of-pocket expenditures among low-income adults. Findings have an important policy implication to protect poor late middle-aged population; as this population enters old age, the high financial burden it faces may exacerbate persistent socioeconomic health disparity among older people with unstable insurance coverage.
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Affiliation(s)
- Eunsun Kwon
- Center for Social Science, Seoul National University, Seoul, South Korea
| | - Sojung Park
- George Warren Brown School of Social Work, Washington University, Saint Louis, MO
| | - Timothy D McBride
- George Warren Brown School of Social Work, Washington University, Saint Louis, MO
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Wiener RC, Vohra R, Sambamoorthi U, Madhavan SS. Caregiver Burdens and Preventive Dental Care for Children with Autism Spectrum Disorder, Developmental Disability and/or Mental Health Conditions: National Survey of CSHCN, 2009-2010. Matern Child Health J 2018; 20:2573-2580. [PMID: 27465058 DOI: 10.1007/s10995-016-2083-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective The purpose of this study is to examine the burdens of caregivers on perception of the need and receipt of preventive dental care for a subset of children with special health care needs-children with Autism Spectrum disorder, developmental disability and/or mental health conditions (CASD/DD/MHC). Methods The authors used the 2009-2010 National Survey of CSHCN. The survey included questions addressing preventive dental care and caregivers' financial, employment, and time-related burdens. The associations of these burdens on perceptions and receipt of preventive dental care use were analyzed with bivariate Chi square analyses and multinomial logistic regressions for CASD/DD/MHC (N = 16,323). Results Overall, 16.3 % of CASD/DD/MHC had an unmet preventive dental care need. There were 40.0 % of caregivers who reported financial burden, 20.3 % who reported employment burden, and 10.8 % who reported time burden. A higher percentage of caregivers with financial burden, employment burden, and time-related burden reported that their CASD/DD/MHC did not receive needed preventive dental care (14.1, 16.5, 17.7 % respectively) compared to caregivers without financial, employment, or time burdens (9.0, 9.6 %, 11.0 % respectively). Caregivers with financial burden (adjusted multinomial odds ratio, 1.38 [95 % CI 1.02, 1.86] and employment burden (adjusted multinomial odds ratio, 1.45 [95 % CI 1.02, 2.06] were more likely to report that their child did not receive preventive dental care despite perceived need compared to caregivers without financial or employment burdens. Conclusions for practice Unmet needs for preventive dental care were associated with employment and financial burdens of the caregivers of CASD/DD/MHC.
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Affiliation(s)
- R Constance Wiener
- Dental Practice and Rural Health, School of Dentistry, West Virginia University, Robert C. Byrd Health Sciences Center Addition 104a, PO Box 9448, Morgantown, WV, 26506, USA.
| | - Rini Vohra
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26505 9510, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26505 9510, USA
| | - S Suresh Madhavan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, 26505 9510, USA
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Nipp RD, Kirchhoff AC, Fair D, Rabin J, Hyland KA, Kuhlthau K, Perez GK, Robison LL, Armstrong GT, Nathan PC, Oeffinger KC, Leisenring WM, Park ER. Financial Burden in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2017; 35:3474-3481. [PMID: 28817372 PMCID: PMC5648170 DOI: 10.1200/jco.2016.71.7066] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study. Participants reported their household income, out-of-pocket medical costs, and issues related to financial burden (questions were adapted from national surveys on financial burden). Logistic regression identified associations between participant characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden, adjusting for potential confounders. Results Among 580 survivors of childhood cancer and 173 siblings, survivors of childhood cancer were more likely to have out-of-pocket medical costs ≥ 10% of annual income (10.0% v 2.9%; P < .001). Characteristics of the survivors of childhood cancer that were associated with a higher percentage of income spent on out-of-pocket costs included hospitalization in the past year (odds ratio [OR], 2.3; 95% CI, 1.1 to 4.9) and household income < $50,000 (OR, 5.5; 95% CI, 2.4 to 12.8). Among survivors of childhood cancer, a higher percentage of income spent on out-of-pocket medical costs was significantly associated with problems paying medical bills (OR, 8.9; 95% CI, 4.4 to 18.0); deferring care for a medical problem (OR, 3.0; 95% CI, 1.6 to 5.9); skipping a test, treatment, or follow-up (OR, 2.1; 95% CI, 1.1 to 4.0); and thoughts of filing for bankruptcy (OR, 6.6; 95% CI, 3.0 to 14.3). Conclusion Survivors of childhood cancer are more likely to report spending a higher percentage of their income on out-of-pocket medical costs, which may influence their health-seeking behavior and potentially affect health outcomes. Our findings highlight the need to address financial burden in this population with long-term health care needs.
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Affiliation(s)
- Ryan D. Nipp
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anne C. Kirchhoff
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Douglas Fair
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Julia Rabin
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kelly A. Hyland
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Karen Kuhlthau
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Giselle K. Perez
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Leslie L. Robison
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Gregory T. Armstrong
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Paul C. Nathan
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kevin C. Oeffinger
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Wendy M. Leisenring
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elyse R. Park
- Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA
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Barbaret C, Brosse C, Rhondali W, Ruer M, Monsarrat L, Michaud P, Schott AM, Delgado-Guay M, Bruera E, Sanchez S, Filbet M. Financial distress in patients with advanced cancer. PLoS One 2017; 12:e0176470. [PMID: 28545063 PMCID: PMC5436643 DOI: 10.1371/journal.pone.0176470] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/11/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose We examined the frequency and severity of financial distress (FD) and its association with quality of life (QOL) and symptoms among patients with advanced cancer in France. Design In this cross-sectional study, 143 patients with advanced cancer were enrolled. QOL was assessed using the Functional Assessment of Cancer General (FACT-G) and symptoms assessed using Edmonton Assessment System (ESAS) and Hospital Anxiety and Depression Scale (HADS). FD was assessed using a self-rated numeric scale from 0 to 10. Results Seventy-three (51%) patients reported having FD. Patients reported having FD were most likely to be younger (53.8 (16,7SD) versus 62 (10.5SD), p<0.001), single (33 (62%) versus 40(44%), p = 0.03) and had a breast cancer (26 (36%), p = 0.024). Patients with FD had a lower FACT-G score (59 versus 70, p = 0.005). FD decreased physical (14 versus 18, p = 0.008), emotional (14 versus 16, p = 0.008), social wellbeing (17 versus 19, p = 0.04). Patients with FD had higher HADS-D (8 versus 6 p = 0.007) and HADS-A (9 versus 7, p = 0.009) scores. FD was linked to increased ESAS score (59 (18SD) versus 67 (18SD), p = 0.005) and spiritual suffering (22(29SD) versus 13(23SD), p = 0.045). Conclusion The high rate of patient-reported FD was unexpected in our studied population, as the French National Health Insurance covers specific cancer treatments. The FD was associated with a poorer quality of life. Having a systematic assessment, with a simple tool, should lead to future research on interventions that will increase patients’ QOL.
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Affiliation(s)
- Cécile Barbaret
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Christelle Brosse
- Departement of Palliative Care, Institut de Cancérologie de la Loire, Saint-Etienne. France
| | - Wadih Rhondali
- Department of Supportive and Palliative Care, Centre Hospitalier Lyon-Sud, Lyon. France
| | | | | | - Patrick Michaud
- Department of Supportive and Palliative Care, Centre Hospitalier Lyon-Sud, Lyon. France
| | | | - Marvin Delgado-Guay
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston Texas, Unites States of America
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, MD Anderson Cancer Center, Houston Texas, Unites States of America
| | - Stéphane Sanchez
- Department of Medical Information Evaluation and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Marilène Filbet
- Department of Supportive and Palliative Care, Centre Hospitalier Lyon-Sud, Lyon. France
- * E-mail:
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23
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Abramowitz J, O'Hara B, Morris DS. Risking Life and Limb: Estimating a Measure of Medical Care Economic Risk and Considering its Implications. HEALTH ECONOMICS 2017; 26:469-485. [PMID: 26880395 DOI: 10.1002/hec.3325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 06/05/2023]
Abstract
This paper considers the risk of incurring future medical expenditures in light of a family's resources available to pay for those expenditures as well as their choice of health insurance. We model non-premium medical out-of-pocket expenditures and use the estimates from our model to develop a prospective measure of medical care economic risk estimating the proportion of families who are at risk of incurring high non-premium out-of-pocket medical care expenses in relation to its resources. We further use the estimates from our model to compare the extent to which different types of insurance mitigate the risk of incurring non-premium expenditures by providing for increased utilization of medical care. We find that while 21.3% of families lack the resources to pay for the median expenditures for their insurance type, 42.4% lack the resources to pay for the 99th percentile of expenditures for their insurance type. We also find the mediating effect of insurance on non-premium expenditures to outweigh the associated premium expense for expenditures above $1804 for employer-sponsored insurance and $4337 for direct purchase insurance for those younger than age 65; and above $12 118 of expenditures for Medicare supplementary plans for those aged 65 or older. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
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24
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Kang HA, Barner JC. The relationship between out-of-pocket healthcare expenditures and insurance status among individuals with chronic obstructive pulmonary disease. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Hyeun Ah Kang
- College of Pharmacy; The University of Texas at Austin; Austin TX USA
| | - Jamie C. Barner
- College of Pharmacy; The University of Texas at Austin; Austin TX USA
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25
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Sukeri S, Mirzaei M, Jan S. Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia. Int Health 2016; 9:29-35. [DOI: 10.1093/inthealth/ihw054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/23/2016] [Accepted: 11/16/2016] [Indexed: 11/14/2022] Open
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26
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Hill SC. Medicaid expansion in opt-out states would produce consumer savings and less financial burden than exchange coverage. Health Aff (Millwood) 2016; 34:340-9. [PMID: 25631764 DOI: 10.1377/hlthaff.2014.1058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the twenty-three states that have decided against expanding Medicaid under the Affordable Care Act, uninsured adults who would have been eligible for Medicaid and have incomes at or above the federal poverty guidelines are generally eligible for Marketplace (insurance exchange) premium tax credits and plans with generous benefits. This study compared estimated out-of-pocket spending for care and premiums, as well as the financial burdens they impose, for the families of these adults under two simulation scenarios: obtaining coverage through a silver plan with subsidized cost sharing and enrolling in expanded Medicaid. Compared with Marketplace coverage, Medicaid would more than halve average annual out-of-pocket spending ($938 versus $1,948), while dramatically reducing the percentage of adults in families with out-of-pocket expenses exceeding 10 percent or 20 percent of income (6.0 percent versus 17.1 percent and 0.9 percent versus 3.7 percent, respectively). Larger reductions would be seen for families with smokers, who under Medicaid would no longer be subject to Marketplace tobacco user surcharges. Medicaid expansion may offer a greater opportunity than access to Marketplace insurance to promote the financial well-being of previously uninsured low-income adults.
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Affiliation(s)
- Steven C Hill
- Steven C. Hill is a senior economist in the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland
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27
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Baird KE. Recent trends in the probability of high out-of-pocket medical expenses in the United States. SAGE Open Med 2016; 4:2050312116660329. [PMID: 27651901 PMCID: PMC5019364 DOI: 10.1177/2050312116660329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 06/20/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This article measures the probability that out-of-pocket expenses in the United States exceed a threshold share of income. It calculates this probability separately by individuals' health condition, income, and elderly status and estimates changes occurring in these probabilities between 2010 and 2013. DATA AND METHOD This article uses nationally representative household survey data on 344,000 individuals. Logistic regressions estimate the probabilities that out-of-pocket expenses exceed 5% and alternatively 10% of income in the two study years. These probabilities are calculated for individuals based on their income, health status, and elderly status. RESULTS Despite favorable changes in both health policy and the economy, large numbers of Americans continue to be exposed to high out-of-pocket expenditures. For instance, the results indicate that in 2013 over a quarter of nonelderly low-income citizens in poor health spent 10% or more of their income on out-of-pocket expenses, and over 40% of this group spent more than 5%. Moreover, for Americans as a whole, the probability of spending in excess of 5% of income on out-of-pocket costs increased by 1.4 percentage points between 2010 and 2013, with the largest increases occurring among low-income Americans; the probability of Americans spending more than 10% of income grew from 9.3% to 9.6%, with the largest increases also occurring among the poor. CONCLUSION The magnitude of out-of-pocket's financial burden and the most recent upward trends in it underscore a need to develop good measures of the degree to which health care policy exposes individuals to financial risk, and to closely monitor the Affordable Care Act's success in reducing Americans' exposure to large medical bills.
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Affiliation(s)
- Katherine E Baird
- Division of Politics, Philosophy and Public Affairs, University of Washington Tacoma, Tacoma, WA, USA
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28
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Saleh S, Mourad Y, Dimassi H, Hitti E. Distribution and predictors of emergency department charges: the case of a tertiary hospital in Lebanon. BMC Health Serv Res 2016; 16:97. [PMID: 26993108 PMCID: PMC4797130 DOI: 10.1186/s12913-016-1337-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/07/2016] [Indexed: 12/05/2022] Open
Abstract
Background As health care costs continue to increase worldwide, health care systems, and more specifically hospitals are facing continuous pressure to operate more efficiently. One service within the hospital sector whose cost structure has been modestly investigated is the Emergency Department (ED). The study aims to report on the distribution of ED resource use, as expressed in charges, and to determine predictors of/contributors to total ED charges at a major tertiary hospital in Lebanon. Methods The study used data extracted from the ED discharge database for visits between July 31, 2012 and July 31, 2014. Patient visit bills were reported under six major categories: solutions, pharmacy, laboratory, physicians, facility, and radiology. Characteristics of ED visits were summarized according to patient gender, age, acuity score, and disposition. Univariate and multivariate analyses were conducted with total charges as the dependent variable. Results Findings revealed that the professional fee (40.9 %) followed by facility fee (26.1 %) accounted for the majority of the ED charges. While greater than 80 % of visit charges went to physician and facility fee for low acuity cases, these contributed to only 52 and 54 % of the high acuity presentations where ancillary services and solutions’ contribution to the total charges increased. The total charges for males were $14 higher than females; age was a predictor of higher charges with total charges of patients greater than 60 years of age being around $113 higher than ages 0–18 after controlling for all other variables. Conclusion Understanding the components and determinants of ED charges is essential to developing cost-containment interventions. Institutional modeling of charging patterns can be used to offer price estimates to ED patients who request this information and ultimately help create market competition to drive down costs.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Yara Mourad
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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29
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Choi S. Sub-Ethnic and Geographic Variations in Out-of-Pocket Private Health Insurance Premiums Among Mid-Life Asians. J Aging Health 2016; 29:222-246. [PMID: 26944806 DOI: 10.1177/0898264316635563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study examined out-of-pocket premium burden of mid-life Asian Americans by comparing six sub-groups of Asians after controlling for geographic clustering at the county and state levels. METHOD The 2007-2011 National Health Interview Survey was linked to community-level data and analyzed for 4,628 Asians (ages 50-64), including 697 Asian Indians, 1,125 Chinese, 1,393 Filipinos, 434 Japanese, 524 Koreans, and 455 Vietnamese. Non-Hispanic Whites were included as a comparison group ( n = 48,135). Three-level multilevel modeling (state > county > individual) was conducted. RESULTS Koreans and Vietnamese were found as vulnerable sub-groups considering their lower private health insurance rates and higher uninsured rates. Among those with private insurance, Asians, specifically Filipinos, paid significantly less than non-Hispanic Whites. Moderate but significant variations in the county- and state-level variance in out-of-pocket premiums were found, especially among mid-life Asians. DISCUSSION This study demonstrates the importance of examining within-group heterogeneity and geographic variations in understanding premium burden among mid-life Asians.
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Affiliation(s)
- Sunha Choi
- 1 The University of Tennessee, Knoxville, USA
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30
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Zallman L, Nardin R, Sayah A, McCormick D. Perceived affordability of health insurance and medical financial burdens five years in to Massachusetts health reform. Int J Equity Health 2015; 14:113. [PMID: 26511105 PMCID: PMC4625927 DOI: 10.1186/s12939-015-0235-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. METHODS We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. RESULTS We found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast, patients with low cost-sharing public plans reported higher plan satisfaction and less financial concern than the commercially insured. CONCLUSIONS Policy makers with responsibility for the benefit design of public insurance available under health care reforms in the U.S. should calibrate cost-sharing to income level so as to minimize difficulty affording care and financial burdens.
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Affiliation(s)
- Leah Zallman
- Cambridge Health Alliance Department of Medicine, 1493 Cambridge St; Macht 420, Cambridge, MA, 02139, USA. .,Institute for Community Health, Malden, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Rachel Nardin
- Cambridge Health Alliance Department of Medicine, 1493 Cambridge St; Macht 420, Cambridge, MA, 02139, USA.,Harvard Medical School, Boston, MA, USA
| | - Assaad Sayah
- Harvard Medical School, Boston, MA, USA.,Cambridge Health Alliance, Cambridge, MA, USA
| | - Danny McCormick
- Cambridge Health Alliance Department of Medicine, 1493 Cambridge St; Macht 420, Cambridge, MA, 02139, USA.,Harvard Medical School, Boston, MA, USA
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Bernard D, Selden T, Yeh S. Financial burdens and barriers to care among nonelderly adults: The role of functional limitations and chronic conditions. Disabil Health J 2015; 9:256-64. [PMID: 26564557 DOI: 10.1016/j.dhjo.2015.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/17/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with functional limitations and chronic conditions account for the greatest resource use within the health care system. OBJECTIVE To examine financial burdens and barriers to care among nonelderly adults, focusing on the role of functional limitations and chronic conditions. METHODS High financial burden is defined as medical spending exceeding 20 percent of family income. Financial barriers are defined as delaying care/being unable to get care for financial reasons, and reporting that delaying care/going without was a big problem. Data are from the Medical Expenditure Panel Survey (2008-2012). RESULTS Functional limitations are associated with increased prevalence of financial burdens. Among single adults, the frequency of high burdens is 20.3% for those with functional limitations, versus 7.8% for those without. Among those with functional limitations, those with 3 or more chronic conditions are twice as likely to have high burdens compared to those without chronic conditions (22.2% versus 11.1%, respectively). Similar patterns occur among persons in multi-person families whose members have functional limitations and chronic conditions. Having functional limitations and chronic conditions is also strongly associated with financial barriers to care: 40.2% among the uninsured, 21.9% among those with public coverage, and 13.6% among those with private group insurance were unable to get care. CONCLUSIONS Functional limitations and chronic conditions are associated with increased prevalence of burdens and financial barriers in all insurance categories, with the exception that an association between functional limitations and the prevalence of burdens was not observed for public coverage.
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Affiliation(s)
- Didem Bernard
- Agency for Healthcare Research and Quality (AHRQ), USA.
| | - Thomas Selden
- Agency for Healthcare Research and Quality (AHRQ), USA
| | - Susan Yeh
- Johns Hopkins School of Public Health, USA
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Jing L, Bai J, Sun X, Zakus D, Lou J, Li M, Zhang Q, Zhuang Y. NRCMS capitation reform and effect evaluation in Pudong New Area of Shanghai. Int J Health Plann Manage 2015; 31:e131-57. [DOI: 10.1002/hpm.2302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Limei Jing
- Pudong Institute for Health Development; Shanghai 200129 China
| | - Jie Bai
- Pudong Institute for Health Development; Shanghai 200129 China
- School of Public Health; Fudan University; Shanghai 200031 China
| | - Xiaoming Sun
- Pudong Institute for Health Development; Shanghai 200129 China
- Pudong New Area Health and Family Planning Commission; Shanghai 200125 China
| | - David Zakus
- Global Health, Community Engagement; University of Alberta; Edmonton Alberta T6G 1C9 Canada
| | - Jiquan Lou
- School of Public Health; Fudan University; Shanghai 200031 China
| | - Ming Li
- Pudong New Area Health and Family Planning Commission; Shanghai 200125 China
| | - Qunfang Zhang
- Pudong New Area New Rural Cooperative Medical Scheme Management Office; Shanghai 201300 China
| | - Yuehong Zhuang
- Pudong New Area Health and Family Planning Commission; Shanghai 200125 China
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Delgado-Guay M, Ferrer J, Rieber AG, Rhondali W, Tayjasanant S, Ochoa J, Cantu H, Chisholm G, Williams J, Frisbee-Hume S, Bruera E. Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. Oncologist 2015. [PMID: 26205738 DOI: 10.1634/theoncologist.2015-0026] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa. PATIENTS AND METHODS We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]). RESULTS The patients' median age was 60 years (95% confidence interval [CI]: 58.6-61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic (p < .0001). FD was present in 65 of 75 at CCC (86%; 95% CI: 76%-93%) versus 65 of 72 at GPH (90%; 95% CI: 81%-96%; p = .45). The median intensity of FD at CCC and GPH was 4 (interquartile range [IQR]: 1-7) versus 8 (IQR: 3-10), respectively (p = .0003). FD was reported as more severe than physical distress, distress about physical functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) (p < .05). AdCa reported that FD was affecting their general well-being (0 = not at all, 10 = very much) with a median score of 5 (IQR: 1-8). FD correlated (Spearman correlation) with FACT-G (r = -0.23, p = .0057); HADS-anxiety (r = .27, p = .0014), ESAS-anxiety (r = .2, p = .0151), and ESAS-depression (r = .18, p = .0336). CONCLUSION FD was very frequent in both groups, but median intensity was double among GPH patients. More than 30% of AdCa rated FD to be more severe than physical, family, and emotional distress. More research is needed to better characterize FD and its correlates in AdCa and possible interventions. IMPLICATIONS FOR PRACTICE Financial distress is an important and common factor contributing to the suffering of advanced cancer patients and their caregivers. It should be suspected in patients with persistent, refractory symptom expression. Early identification, measurement, and documentation will allow clinical teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients.
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Affiliation(s)
- Marvin Delgado-Guay
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jeanette Ferrer
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alyssa G Rieber
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Wadih Rhondali
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Supakarn Tayjasanant
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jewel Ochoa
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Hilda Cantu
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gary Chisholm
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Janet Williams
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Susan Frisbee-Hume
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Eduardo Bruera
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Vatovec C, Erten MZ, Kolodinsky J, Brown P, Wood M, James T, Sprague BL. Ductal carcinoma in situ: a brief review of treatment variation and impacts on patients and society. Crit Rev Eukaryot Gene Expr 2015; 24:281-6. [PMID: 25403959 DOI: 10.1615/critreveukaryotgeneexpr.2014011495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Nearly 20% of all breast cancer cases are ductal carcinoma in situ (DCIS), with over 60,000 cases diagnosed each year. Many of these cases would never cause clinical symptoms or threaten the life of the woman; however, it is currently impossible to distinguish which lesions will progress to invasive disease from those that will not. DCIS is generally associated with an excellent prognosis regardless of the treatment pathway, but there is variation in treatment aggressiveness that seems to exceed the medical uncertainty associated with DCIS management. Therefore, it would seem that a significant proportion of women with DCIS receive more extensive treatment than is needed. This overtreatment of DCIS is a growing concern among the breast cancer community and has implications for both the patient (via adverse treatment-related effects, as well as out-of-pocket costs) and society (via economic costs and the public health and environmental harm resulting from health care delivery). This article discusses DCIS treatment pathways and their implications for patients and society and calls for further research to examine the factors that are leading to such wide variation in treatment decisions.
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Affiliation(s)
- Christine Vatovec
- Rubenstein School of Environment and Natural Resources & College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Mujde Z Erten
- Department of Surgery, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont; Global Health Economics Unit of the Vermont Center for Clinical and Translational Science, University of Vermont, Burlington, Vermont
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, Vermont
| | - Phil Brown
- Department of Sociology and Anthropology, Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Marie Wood
- Department of Medicine, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Ted James
- Department of Surgery, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Brian L Sprague
- Department of Surgery, College of Medicine, Vermont Cancer Center, University of Vermont, Burlington, Vermont
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Riggs KR, Buttorff C, Alexander GC. Impact of out-of-pocket spending caps on financial burden of those with group health insurance. J Gen Intern Med 2015; 30:683-8. [PMID: 25472507 PMCID: PMC4395601 DOI: 10.1007/s11606-014-3127-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/16/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) mandates that all private health insurance include out-of-pocket spending caps. Insurance purchased through the ACA's Health Insurance Marketplace may qualify for income-based caps, whereas group insurance will not have income-based caps. Little is known about how out-of-pocket caps impact individuals' health care financial burden. OBJECTIVE We aimed to estimate what proportion of non-elderly individuals with group insurance will benefit from out-of-pocket caps, and the effect that various cap levels would have on their financial burden. DESIGN We applied the expected uniform spending caps, hypothetical reduced uniform spending caps (reduced by one-third), and hypothetical income-based spending caps (similar to the caps on Health Insurance Marketplace plans) to nationally representative data from the Medical Expenditure Panel Survey (MEPS). PARTICIPANTS Participants were non-elderly individuals (aged < 65 years) with private group health insurance in the 2011 and 2012 MEPS surveys (n =26,666). MAIN MEASURES (1) The percentage of individuals with reduced family out-of-pocket spending as a result of the various caps; and (2) the percentage of individuals experiencing health care services financial burden (family out-of-pocket spending on health care, not including premiums, greater than 10% of total family income) under each scenario. KEY RESULTS With the uniform caps, 1.2% of individuals had lower out-of-pocket spending, compared with 3.8% with reduced uniform caps and 2.1% with income-based caps. Uniform caps led to a small reduction in percentage of individuals experiencing financial burden (from 3.3% to 3.1%), with a modestly larger reduction as a result of reduced uniform caps (2.9%) and income-based caps (2.8%). CONCLUSIONS Mandated uniform out-of-pocket caps for those with group insurance will benefit very few individuals, and will not result in substantial reductions in financial burden.
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Affiliation(s)
- Kevin R Riggs
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA,
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Choi S. Out-of-pocket expenditures and the financial burden of healthcare among older adults: by nativity and length of residence in the United States. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 58:149-170. [PMID: 25036656 DOI: 10.1080/01634372.2014.943447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Newly arrived older immigrants in the United States tend to be greatly affected by increasing out-of-pocket healthcare expenditures due to their limited insurance options. To examine such disparities in the out-of-pocket expenditures, this study analyzed the Medical Expenditure Panel Survey by immigrant status. Major findings of this study indicated that although recent immigrants had lower total healthcare expenditures, they spent much higher proportions of their annual income on out-of-pocket medical payments, compared with their US-born counterparts. Dramatically higher out-of-pocket burdens among recent immigrants represent a barrier to necessary healthcare, which needs to be addressed from both public health and economic perspectives.
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Affiliation(s)
- Sunha Choi
- a College of Social Work , The University of Tennessee at Knoxville , Knoxville , Tennessee , USA
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Abstract
This article uses the 2013 Current Population Survey Annual Social and Economic Supplement to estimate the financial burden of medical out-of-pocket costs by comparing medical out-of-pocket expenditures to income. This measure is important for evaluating the magnitude of burden, better understanding who bears it, and establishing a baseline to assess the impact of the Patient Protection and Affordable Care Act. We examine the distribution of burden and the incidence of high burden across all families and by individuals’ health insurance status and demographic and socioeconomic characteristics. We look more closely at one group vulnerable to having high burden: those younger than age 65 with incomes between 138% and 200% of the federal poverty line. We find that 18.5% of these individuals have incomes below the threshold of expansion Medicaid eligibility after accounting for non-over-the-counter medical expenses and examine the characteristics associated with being classified below this threshold.
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Wisk LE, Gangnon R, Vanness DJ, Galbraith AA, Mullahy J, Witt WP. Development of a novel, objective measure of health care-related financial burden for U.S. families with children. Health Serv Res 2014; 49:1852-74. [PMID: 25328073 DOI: 10.1111/1475-6773.12248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To develop and validate a theoretically based and empirically driven objective measure of financial burden for U.S. families with children. DATA SOURCES The measure was developed using 149,021 families with children from the National Health Interview Survey, and it was validated using 18,488 families with children from the Medical Expenditure Panel Survey. STUDY DESIGN We estimated the marginal probability of unmet health care need due to cost using a bivariate tensor product spline for family income and out-of-pocket health care costs (OOPC; e.g., deductibles, copayments), while adjusting for confounders. Recursive partitioning was performed on these probabilities, as a function of income and OOPC, to establish thresholds demarcating levels of predicted risk. PRINCIPAL FINDINGS We successfully generated a novel measure of financial burden with four categories that were associated with unmet need (vs. low burden: midlow OR: 1.93, 95 percent CI: 1.78-2.09; midhigh OR: 2.78, 95 percent CI: 2.49-3.10; high OR: 4.38, 95 percent CI: 3.99-4.80). The novel burden measure demonstrated significantly better model fit and less underestimation of financial burden compared to an existing measure (OOPC/income ≥ 10 percent). CONCLUSION The newly developed measure of financial burden establishes thresholds based on different combinations of family income and OOPC that can be applied in future studies of health care utilization and expenditures and in policy development and evaluation.
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Affiliation(s)
- Lauren E Wisk
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Population Health Sciences, School of Medicine and Public Health University of Wisconsin, Madison, Madison, WI
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Richman IB, Brodie M. A National study of burdensome health care costs among non-elderly Americans. BMC Health Serv Res 2014; 14:435. [PMID: 25252706 PMCID: PMC4261537 DOI: 10.1186/1472-6963-14-435] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/16/2014] [Indexed: 11/16/2022] Open
Abstract
Background Rising health care costs and increased cost sharing have resulted in significant medical expenses for many Americans. The goal of this study was to describe the prevalence of and risk factors for burdensome health care costs among non-elderly Americans. Methods This was a cross sectional study of a nationally representative sample of non-elderly Americans. We used survey data previously collected by the Kaiser Family Foundation. We used logistic regression to identify key risk factors for burdensome health care costs and to assess whether risk factors differ according to age within our study population. For analyses comparing younger and middle-aged adults, we compared participants ages 18–39 (younger Americans) to those ages 40–64 (middle-aged Americans). Results Our study population included 5,493 participants. Twenty seven percent of participants reported difficulty paying medical bills, a prevalence that did not differ by age. Low income, lack of health insurance, and poor health were independently associated with difficulty paying medical bills after controlling for demographic covariates. Both younger and middle-aged adults were likely to experience burdensome health care costs at low incomes. At moderate incomes, risk fell for middle-aged adults, but remained high for younger adults (ORmiddle-age 1.40, 95% CI 1.12-1.75, ORyounger 2.48, 95% CI 1.73-3.57, p value for interaction 0.004). Younger adults without insurance were at risk for accruing burdensome costs compared to their insured counterparts (OR 2.61, 95% CI 1.96-3.47). Middle-aged adults without insurance, though, had an even higher risk (OR 3.82, 95% CI 2.93-4.97, p value for interaction 0.037). Conclusions Both younger and middle-aged adults commonly report difficulty paying medical bills. Younger adults remain vulnerable to burdensome medical costs even when earning moderate incomes. Middle-aged adults, however, are more likely to encounter burdensome costs when uninsured. These findings suggest that younger and middle-aged adults experience distinct vulnerabilities and may benefit differentially from health reform efforts intended to expand coverage and limit out-of-pocket expenses.
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Affiliation(s)
- Ilana B Richman
- Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA.
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Fletcher RA. Keeping up with the Cadillacs: What Health Insurance Disparities, Moral Hazard, and the Cadillac Tax Mean to The Patient Protection and Affordable Care Act. Med Anthropol Q 2014; 30:18-36. [PMID: 25132244 DOI: 10.1111/maq.12120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A major goal of The Patient Protection and Affordable Care Act is to broaden health care access through the extension of insurance coverage. However, little attention has been given to growing disparities in access to health care among the insured, as trends to reduce benefits and increase cost sharing (deductibles, co-pays) reduce affordability and access. Through a political economic perspective that critiques moral hazard, this article draws from ethnographic research with the United Steelworkers (USW) at a steel mill and the Retail, Wholesale and Department Store Union (RWDSU) at a food-processing plant in urban Central Appalachia. In so doing, this article describes difficulties of health care affordability on the eve of reform for differentially insured working families with employer-sponsored health insurance. Additionally, this article argues that the proposed Cadillac tax on high-cost health plans will increase problems with appropriate health care access and medical financial burden for many families.
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de Souza JA, Yap BJ, Hlubocky FJ, Wroblewski K, Ratain MJ, Cella D, Daugherty CK. The development of a financial toxicity patient-reported outcome in cancer: The COST measure. Cancer 2014; 120:3245-53. [PMID: 24954526 DOI: 10.1002/cncr.28814] [Citation(s) in RCA: 351] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/29/2014] [Accepted: 04/17/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Considering patients' experience is essential for optimal decision-making. However, despite increasing recognition of the impact of costs on oncology care, there is no patient-reported outcome measure (PROM) that specifically describes the financial distress experienced by patients. METHODS The content for a comprehensive score for financial toxicity (COST) was developed with a stepwise approach: step 1) a literature review and semistructured, qualitative interviews with patients for content generation; step 2) patients' assessment of the items for importance to their quality of life; step 3) pilot testing assessing interitem (IIC) and item-total (ITC) correlations to identify redundancy (Spearman rho, > 0.7) and statistically unrelated content (P > .05); and step 4) exploratory factor analysis. Sociodemographic data were collected. RESULTS In total, 155 patients with advanced cancer who were receiving treatment (20 patients in step 1, 35 patients in step 2, and 100 patients in steps 3 and 4) participated in the PROM development. In step 1, the literature was reviewed, and 20 patients generated 147 items, which were reduced to 58 items because of redundancy. In step 2, 35 patients rated the 58 items on importance, and 30 items were retained. In step 3, 46 patients assessed the 30 items, 14 items were excluded because of high IIC, and 3 were excluded because of nonsignificant ITC. In step 4, 2 items were discarded because of poor loadings in a factor analysis of 100 patients, resulting in an 11-item PROM. CONCLUSIONS The content for a financial toxicity PROM was developed in 155 patients. The provisional COST measure demonstrated face and content validity as well as internal consistency and should be validated in larger samples.
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Affiliation(s)
- Jonas A de Souza
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois
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Cohen SB, Cohen JW. The capacity of the Medical Expenditure Panel Survey to inform the Affordable Care Act. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2014; 50:124-34. [PMID: 24574130 DOI: 10.1177/0046958013513678] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Affordable Care Act (ACA) was enacted with major provisions to expand health insurance coverage, control health care costs, and improve the health care delivery system. Essential data resources will be required for effective program planning, administration, and management, in addition to facilitating evaluations of program performance. The Medical Expenditure Panel Survey (MEPS) is one of the core data resources that has been used to inform several provisions of the ACA. This paper provides a summary of the capacity of the MEPS to inform program planning, implementation, and evaluations of program performance for several components of the ACA.
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Affiliation(s)
- Steven B Cohen
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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Li R, Barker LE, Shrestha S, Zhang P, Duru OK, Pearson-Clarke T, Gregg EW. Changes over time in high out-of-pocket health care burden in U.S. adults with diabetes, 2001-2011. Diabetes Care 2014; 37:1629-35. [PMID: 24667459 PMCID: PMC4914036 DOI: 10.2337/dc13-1997] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE High out-of-pocket (OOP) costs can be an obstacle to health care access and treatment compliance. This study investigated trends in high OOP health care burden in people with diabetes. RESEARCH DESIGN AND METHODS Using Medical Expenditure Panel Survey 2001-2011 data, we examined trends in the proportion of people aged 18-64 years with diabetes facing a high OOP burden. We also examined whether the trend differed by insurance status (private insurance, public insurance, or no insurance) or by income level (poor and near poor, low income, middle income, or high income). RESULTS In 2011, 23% of people with diabetes faced high OOP burden. Between 2001-2002 and 2011, the proportion of people facing high OOP burden fell by 5 percentage points (P < 0.01). The proportion of those who were publicly insured decreased by 22 percentage points (P < 0.001) and of those who were uninsured by 12 percentage points (P = 0.01). Among people with diabetes who were poor and near poor and those with low income, the proportion facing high OOP burden decreased by 21 (P < 0.001) and 13 (P = 0.01) percentage points, respectively; no significant change occurred in the proportion with private insurance or middle and high incomes between 2001-2002 and 2011. CONCLUSIONS The past decade has seen a narrowing of insurance coverage and income-related disparities in high OOP burden in people with diabetes; yet, almost one-fourth of all people with diabetes still face a high OOP burden.
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Affiliation(s)
- Rui Li
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lawrence E Barker
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sundar Shrestha
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - O Kenrick Duru
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Tony Pearson-Clarke
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Chen LM, Norton EC, Langa KM, Le S, Epstein AM. Geographic variation in out-of-pocket expenditures of elderly Medicare beneficiaries. J Am Geriatr Soc 2014; 62:1097-104. [PMID: 24852182 DOI: 10.1111/jgs.12834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans. DESIGN Retrospective cohort study. SETTING Data from the Health and Retirement Study linked to Medicare claims. PARTICIPANTS A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008. MEASUREMENTS The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums. RESULTS Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001). CONCLUSION Medicare payments vary widely between high- and low-cost regions, but OOPEs do not.
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Affiliation(s)
- Lena M Chen
- Division of General Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Blumberg LJ, Waidmann TA, Blavin F, Roth J. Trends in health care financial burdens, 2001 to 2009. Milbank Q 2014; 92:88-113. [PMID: 24597557 DOI: 10.1111/1468-0009.12042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT Over the past decade, health care spending increased faster than GDP and income, and decreasing affordability is cited as contributing to personal bankruptcies and as a reason that some of the nonelderly population is uninsured. We examined the trends in health care affordability over the past decade, measuring the financial burdens associated with health insurance premiums and out-of-pocket costs and highlighting implications of the Affordable Care Act for the future financial burdens of particular populations. METHODS We used cross sections of the Medical Expenditure Panel Survey Household Component (MEPS-HC) from 2001 to 2009. We defined financial burden at the health insurance unit (HIU) level and calculated it as the ratio of expenditures on health care-employer-sponsored insurance coverage (ESI) and private nongroup premiums and out-of-pocket payments-to modified adjusted gross income. FINDINGS The median health care financial burden grew on average by 2.7% annually and by 21.9% over the period. Using a range of definitions, the fraction of households facing high financial burdens increased significantly. For example, the share of HIUs with health care expenses exceeding 10% of income increased from 35.9% to 44.8%, a 24.8% relative increase. The share of the population in HIUs with health care financial burdens between 2% and 10% fell, and the share with burdens between 10% and 44% rose. CONCLUSIONS We found a clear trend over the past decade toward an increasing share of household income devoted to health care. The ACA will affect health care spending for subgroups of the population differently. Several groups' burdens will likely decrease, including those becoming eligible for Medicaid or subsidized private insurance and those with expensive medical conditions. Those newly obtaining coverage might increase their health spending relative to income, but they will gain access to care and the ability to spread their expenditures over time, both of which have demonstrable economic value.
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Bock JO, Matschinger H, Brenner H, Wild B, Haefeli WE, Quinzler R, Saum KU, Heider D, König HH. Inequalities in out-of-pocket payments for health care services among elderly Germans--results of a population-based cross-sectional study. Int J Equity Health 2014; 13:3. [PMID: 24397544 PMCID: PMC3893415 DOI: 10.1186/1475-9276-13-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/23/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction In order to limit rising publicly-financed health expenditure, out-of-pocket payments for health care services (OOPP) have been raised in many industrialized countries. However, higher health-related OOPP may burden social subgroups unequally. In Germany, inequalities in OOPP have rarely been analyzed. The aim of this study was to examine OOPP of the German elderly population in the different sectors of the health care system. Socio-economic and morbidity-related determinants of inequalities in OOPP were analyzed. Methods This cross-sectional analysis used data of N = 3,124 subjects aged 57 to 84 years from a population-based prospective cohort study (ESTHER study) collected in the Saarland, Germany, from 2008 to 2010. Subjects passed a geriatric assessment, including a questionnaire for health care utilization and OOPP covering a period of three months in the following sectors: inpatient care, outpatient physician and non-physician services, medical supplies, pharmaceuticals, dental prostheses and nursing care. Determinants of OOPP were analyzed by a two-part model. The financial burden of OOPP for certain social subgroups (measured by the OOPP-income-ratio) was investigated by a generalized linear model for the binomial family. Results Mean OOPP during three months amounted to €119, with 34% for medical supplies, 22% for dental prostheses, 21% for pharmaceuticals, 17% for outpatient physician and non-physician services, 5% for inpatient care and 1% for nursing care. The two-part model showed a significant positive association between income (square root equivalence scale) and total OOPP. Increasing morbidity was associated with significantly higher total OOPP, and in particular with higher OOPP for pharmaceuticals. Total OOPP amounted to about 3% of disposable income. The generalized linear model for the binomial family showed a significantly lower financial burden for the wealthiest quintile as compared to the poorest one. Conclusions This is the first study providing evidence of inequalities in OOPP in the German elderly population. Socio-economic and morbidity-related inequalities in OOPP and the resulting financial burden could be identified. The results of this study may contribute to the discussion about the mechanisms causing the observed inequalities and can thus help decision makers to consider them when adapting future regulations on OOPP.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
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Medicare Part D is Associated With Reducing the Financial Burden of Health Care Services in Medicare Beneficiaries With Diagnosed Diabetes. Med Care 2013; 51:888-93. [DOI: 10.1097/mlr.0b013e3182a53d95] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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DiFazio RL, Vessey JA. Non-medical out-of-pocket expenses incurred by families during their child's hospitalization. J Child Health Care 2013; 17:230-41. [PMID: 23711489 DOI: 10.1177/1367493512461459] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about the nonmedical out of pocket expenses (NOOPEs) incurred by families of hospitalized children. The purpose of this study is to help nurses, other healthcare providers, hospital administrators, and policymakers better understand the NOOPEs incurred by families during their child's hospitalization. Parents of children (n = 50) who underwent orthopedic surgery at a major tertiary-care children's hospital reported all NOOPEs incurred during their child's hospitalization. Descriptive statistics and univariate and multiple logistic regression analyses were used to analyze the data. The total NOOPEs ranged from $17.00 to $4745.00 (M = $736.21) per hospitalization, with 2096 missed hours from work. Length of stay, gross family income, distance from the hospital, and Hollingshead score are significant predictors of expenses (F-ratio = 732.88, p < 0.001). Hospitalization is associated with numerous NOOPEs. Future research needs to investigate the total array of expenses to families.
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Abstract
Novel diagnostic and therapeutic options offer hope to cancer patients with both localized and advanced disease. However, many of these treatments are often costly and even well-insured patients can face high out-of-pocket costs. Families may also be at risk of financial distress due to lost wages and other treatment-related expenses. Research is needed to measure and characterize financial distress in cancer patients and understand how it affects their quality of life. In addition, health care providers need to be trained to counsel patients and their families so they can make patient-centered treatment decisions that reflect their preferences and values.
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50
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Karaca-Mandic P, Choi Yoo SJ, Sommers BD. Recession Led To A Decline In Out-Of-Pocket Spending For Children With Special Health Care Needs. Health Aff (Millwood) 2013; 32:1054-62. [DOI: 10.1377/hlthaff.2012.1137] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pinar Karaca-Mandic
- Pinar Karaca-Mandic ( ) is an assistant professor in the Division of Health Policy and Management, School of Public Health, University of Minnesota, in Minneapolis
| | - Sung J. Choi Yoo
- Sung J. Choi Yoo is a doctoral student in the Division of Health Policy and Management, School of Public Health, University of Minnesota
| | - Benjamin D. Sommers
- Benjamin D. Sommers is an assistant professor of health policy and economics at the Harvard School of Public Health and an assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, in Boston, Massachusetts
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