Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011
Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011
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DOI：
10.5888/pcd12.140388
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发表时间：
2015-01-01
影响因子：
5.5
通讯作者：
Sambamoorthi, Usha
中科院分区：
文献类型：
--
作者：
Meraya, Abdulkarim M.;Raval, Amit D.;Sambamoorthi, Usha
前言关于成人慢性疾病的组合如何影响卫生保健总支出，我们知之甚少。我们的目标是通过各种条件的组合来估计美国成年人的年平均总支出和自付支出负担。方法我们利用2009年和2011年医疗支出小组调查的数据进行了一项横断面研究。样本包括9,296名21岁或以上的成年人，至少有以下4种高度流行的慢性疾病中的2种：关节炎、糖尿病、心脏病和高血压。未调整和调整的回归技术被用来检验慢性疾病组合和对数转换后总支出之间的关联。结果在患有慢性疾病的成年人中，患有所有4种疾病的成年人的平均总支出最高(20016美元)，而患有糖尿病/高血压的成年人的年总支出最低(7116美元)。在调整后的模型中，患有糖尿病/高血压和高血压/关节炎的成年人的医疗保健支出低于患有糖尿病/心脏病的成年人(P<；.001)。在调整后的模型中，与糖尿病和心脏病患者相比，患有所有四种疾病的成年人的支出更高。然而，仅有轻微的显著差异(P=0.04)。结论在患有关节炎、糖尿病、心脏病和高血压的成年人中，总的医疗费用因慢性疾病组合的类型而不同。对于患有多种慢性病的个人，如心脏病和糖尿病，需要新的护理管理模式，以减轻支付者的成本负担。
IntroductionLittle is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions.MethodsWe conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden.ResultsAmong adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P < .001). In adjusted models, adults with all 4 conditions had higher expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04).ConclusionAmong adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.