Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?
Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?
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DOI：
10.1371/journal.pone.0222539
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发表时间：
2019-09-20
期刊：
影响因子：
3.7
通讯作者：
Fong, Joelle H.
中科院分区：
文献类型：
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作者：
Fong, Joelle H.
BackgroundLittle是已知的不同类型的慢性疾病对老年人的自付医疗保健支出的影响，以及某些疾病是否会引发更高的支出需求比others.MethodsWe使用的数据从2014年健康和退休研究代表一个加权人口35，939，270医疗保险受益人65岁以上。广义线性模型用于估计不同慢性疾病对自付总支出的影响，并根据人口统计学、社会经济状况、身体健康和其他因素进行调整。我们还按支出类别（住院、非住院和处方药支出）分解了总支出。结果心血管疾病、糖尿病、高血压和癌症等疾病在老年人中的自付费用显著高于其他疾病。无论如何评估支出差异（绝对值或百分比），这些结果都是成立的。对于医疗保险受益人，心血管疾病与每年317美元的额外自付支出相关，其次是糖尿病（237美元），高血压（150美元）和癌症（144美元）。处方药支出是心血管疾病、糖尿病和高血压额外支出的最重要驱动因素，而非住院服务支出占癌症患者支出增加的大部分。ConclusionsOur findings that major non-committees diseases impact individuals' out-of-pocket medical expenditure differently-and that service drivers of the increased expenditure may be heterogeneous across the disease types-建议卫生专业人员和政策制定者应该认识到某些慢性疾病对老年人造成更大的经济损失，促进更具成本效益的医疗保健服务和消费者选择的干预措施可以帮助老年人更好地科普这些昂贵的长期疾病，并减少非传染性疾病的总体负担。
BackgroundLittle is known about the impact of different types of chronic diseases on older adults' out-of-pocket healthcare spending and whether certain diseases trigger higher spending needs than others.MethodsWe use data from the 2014 Health and Retirement Study representing a weighted population of 35,939,270 Medicare beneficiaries aged 65+. Generalized linear models are applied to estimate the effect of different chronic diseases on total out-of-pocket expenditure, adjusted for demographics, socio-economic status, physical health, and other factors. We also decompose total spending by expenditure categories (inpatient, non-inpatient, and prescription drug spending). Sensitivity analysis is performed using a younger sample of older adults aged 50-64.ResultsCardiovascular disease, diabetes, hypertension and cancer, induce significantly higher adjusted out-of-pocket spending among older adults than other conditions. These results hold regardless how the spending differences are assessed (absolute or percentage terms). For Medicare beneficiaries, cardiovascular disease is associated with an excess out-of-pocket spending of $317 per year, followed by diabetes ($237), hypertension ($150), and cancer ($144). Prescription drug spending is singularly the most important driver of additional expenses for cardiovascular disease, diabetes and hypertension, while non-inpatient services spending accounts for the bulk of increased spending among those with cancer.ConclusionsOur finding that major noncommunicable diseases impact individuals' out-of-pocket medical spending differentially-and that service drivers of increased spending may be heterogeneous across disease types-suggest that health professionals and policymakers should recognize that certain chronic diseases exert greater financial toll on the elderly.Interventions to promote more cost efficient healthcare services and consumer choices can help older adults better cope with these expensive long-lasting conditions and reduce the overall burden of noncommunicable diseases.