Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services.
Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services.
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DOI：
10.1177/2381468318760298
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发表时间：
2018-01
影响因子：
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通讯作者：
Politi MC
中科院分区：
文献类型：
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作者：
Smith KT;Monti D;Mir N;Peters E;Tipirneni R;Politi MC
背景：尽管最近扩大了获得医疗保险的机会，但消费者在利用其覆盖范围获得所需医疗保健方面仍面临障碍。目的：调查因费用原因而延误或逃避医疗保健的人群的特征。方法：通过Amazon MTurk招募参与者，并完成一项调查，评估人口统计学特征、财务毒性、医疗保健最小化-最大化倾向、医疗保险知识、计算能力、推迟/避免任何护理以及推迟/避免六项常见医疗服务(三项预防性服务和三项非预防性服务)。当可用时，使用经过验证的措施。延迟/回避行为分为延迟/避免任何护理、预防性护理和非预防性护理。Logistic回归模型分别检查了1)财务毒性、2)最小化-最大化倾向、3)计算能力、4)医疗保险知识和5)预防护理覆盖范围的知识，分别针对三种形式的延误/回避行为，控制慢性病、保险状况和/或适当的收入。结果：在518名受访者中，470名没有未通过注意力检查的问题，并被用于分析。45%的受访者报告说，由于成本的原因，他们推迟/避免了护理。多变量分析发现，经济毒性与推迟/避免任何护理(OR[OR]=0.884，P<；0.001)、预防性护理(OR=0.906，P<；0.001)和非预防性护理(OR=0.901，P<；0.001)有关。倾向于尽量减少寻求医疗保健(OR=0.734，P<；0.001)和较低的主观算术能力(OR=0.794，P=0.023)与延误/逃避任何医疗保健有关。一般健康保险知识(OR=0.989，P=0.023)和预防保健知识(OR=0.422，P<；0.001)与推迟/避免预防保健有关。结论：许多人由于费用的原因推迟或避免医疗保健，即使是在保险的情况下也是如此。结果表明，个人推迟或避免预防性和非预防性护理可能有不同的原因。调查结果可能会为教育消费者的干预措施提供信息，并支持关于卫生保健成本的讨论，以促进适当的卫生保健利用。
Background: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk and completed a survey assessing demographic characteristics, financial toxicity, health care minimizer-maximizer tendencies, health insurance knowledge, numeracy, delaying/avoiding any care, and delaying/avoiding six common health care services (three preventive and three nonpreventive services). Validated measures were used when available. Delay/avoidance behaviors were categorized into delaying/avoiding any care, preventive care, and nonpreventive care. Logistic regression models examined 1) financial toxicity, 2) minimizer-maximizer tendencies, 3) numeracy, 4) health insurance knowledge, and 5) knowledge of preventive care coverage separately on three forms of delay/avoidance behaviors, controlling for chronic conditions, insurance status, and/or income where appropriate. Results: Of 518 respondents, 470 did not fail attention-check questions and were used in analyses. Forty-five percent of respondents reported delaying/avoiding care due to cost. Multivariable analyses found that financial toxicity was related to delaying/avoiding any care (odds ratio [OR] = 0.884, P < 0.001), preventive care (OR = 0.906, P < 0.001), and nonpreventive care (OR = 0.901, P < 0.001). A tendency to minimize seeking health care (OR = 0.734, P < 0.001) and lower subjective numeracy (OR = 0.794, P = 0.023) were related to delaying/avoiding any care. General health insurance knowledge (OR = 0.989, P = 0.023) and knowledge of preventive care coverage (OR = 0.422, P < 0.001) were related to delaying/avoiding preventive care. Conclusions: Many people delay or avoid health care due to costs, even when insured. Results suggest that there may be different reasons individuals delay or avoid preventive and nonpreventive care. Findings may inform interventions to educate consumers and support discussions about health care costs to facilitate appropriate health care utilization.