Changes over time in high out-of-pocket health care burden in U.S. adults with diabetes, 2001-2011.
Changes over time in high out-of-pocket health care burden in U.S. adults with diabetes, 2001-2011.
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DOI：
10.2337/dc13-1997
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发表时间：
2014-06
期刊：
影响因子：
16.2
通讯作者：
Gregg EW
中科院分区：
文献类型：
--
作者：
Li R;Barker LE;Shrestha S;Zhang P;Duru OK;Pearson-Clarke T;Gregg EW
高昂的自付费用（OOP）可能是获得医疗保健和治疗依从性的障碍。本研究调查了糖尿病患者高OOP医疗保健负担的趋势。利用2001 - 2011年医疗支出面板调查数据，我们研究了18 - 64岁糖尿病患者面临高OOP负担的比例趋势。我们还研究了这一趋势是否因保险状况（私人保险、公共保险或无保险）或收入水平（贫困和接近贫困、低收入、中等收入或高收入）而不同。2011年，23%的糖尿病患者面临着高OOP负担。2001 - 2002年至2011年期间，面临高OOP负担的人口比例下降了5个百分点（P <0.01）。公共保险的比例下降了22个百分点（P <0.001），没有保险的比例下降了12个百分点（P = 0.01）。2001 - 2002年与2011年相比，贫困和近贫困糖尿病患者以及低收入糖尿病患者面临高OOP负担的比例分别下降了21（P <0.001）和13（P = 0.01）个百分点;拥有私人保险或中高收入的比例没有发生显著变化。在过去的十年中，糖尿病患者的高OOP负担的保险覆盖范围和收入相关差异缩小;然而，近四分之一的糖尿病患者仍然面临高OOP负担。
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. 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). 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. 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.