Changes in financial burdens for health care - National estimates for the population younger than 65 years, 1996 to 2003
Changes in financial burdens for health care - National estimates for the population younger than 65 years, 1996 to 2003
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DOI：
10.1001/jama.296.22.2712
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发表时间：
2006-12-13
影响因子：
120.7
通讯作者：
Bernard, Didem M.
中科院分区：
文献类型：
--
作者：
Banthin, Jessica S.;Bernard, Didem M.
背景政策制定者和医生需要了解医疗保健成本上升对特定患者群体的影响有多快。目的估计美国面临非常高的医疗保健财务负担的个人的数量和特征。设计、设置和人口数据来自医疗支出小组调查的具有全国代表性的65岁以下的非医疗机构美国平民个人，用于计算作为税收调整家庭收入函数的财务负担的两个衡量标准。总负担包括保健服务的所有自付支出，包括保费。医疗保健服务负担不包括保费，当适用于保险人口时，用于确定保险不足的人。主要指标1996年和2003年医疗服务总负担和医疗服务负担分别超过家庭收入的10%和20%。结果2003年有4880万人(19.2%)的家庭医疗支出超过家庭收入的10%，自1996年以来增加了1170万人。在这些人中，约有1870万人(7.3%)的支出超过家庭收入的20%。2003年，总体负担高的风险高于平均水平的个人包括贫困和低收入者，以及年龄在55岁至之间、居住在非大都市统计区、健康状况一般或较差、有任何类型的限制或患有慢性病的非群体覆盖人群。将我们对保险不足的定义应用到保险人口中，2003年估计有1710万65岁以下的人保险不足，其中930万人参加了私人就业相关保险，130万人参加了私人非团体保险，660万人参加了公共保险。结论我们的分析发现，患者面临着与健康相关的经济负担的最大风险，这可能会对他们获得和坚持推荐的治疗产生不利影响。我们的研究还强调了与非团体健康保险相关的高成本。
Context Policymakers as well as physicians need to understand how rapidly rising health care costs are affecting specific groups of patients.Objective To estimate the number and characteristics of individuals in the United States faced with very high financial burdens for health care.Design, Setting, and Population Data from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys were used to calculate 2 measures of financial burden as a function of tax-adjusted family income. Total burden included all out-of-pocket expenditures for health care services, including premiums. Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured. We defined the underinsured as insured persons with health care service burdens in excess of 10% of tax-adjusted family income.Main Outcome Measures Total and health care services burdens exceeding 10% and 20% of family income in 1996 and 2003.Results In 2003, there were 48.8 million individuals (19.2%) living in families spending more than 10% of family income on health care, an increase of 11.7 million persons since 1996. Of these individuals, about 18.7 million (7.3%) were spending more than 20% of family income. In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income persons and those with non-group coverage, aged 55 to 64 years, living in a non - metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition. Applying our definition of underinsured to the insured population, an estimated 17.1 million persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage.Conclusions Our analysis identifies patients at greatest risk of health-related financial burdens that may adversely affect their access and adherence to recommended treatments. Our study also highlights the high costs associated with nongroup health insurance policies.