1
|
McCoy RG, Swarna KS, Jiang DH, Van Houten HK, Chen J, Davis EM, Herrin J. Enrollment in High-Deductible Health Plans and Incident Diabetes Complications. JAMA Netw Open 2024; 7:e243394. [PMID: 38517436 PMCID: PMC10960199 DOI: 10.1001/jamanetworkopen.2024.3394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/25/2024] [Indexed: 03/23/2024] Open
Abstract
Importance Preventing diabetes complications requires monitoring and control of hyperglycemia and cardiovascular risk factors. Switching to high-deductible health plans (HDHPs) has been shown to hinder aspects of diabetes care; however, the association of HDHP enrollment with microvascular and macrovascular diabetes complications is unknown. Objective To examine the association between an employer-required switch to an HDHP and incident complications of diabetes. Design, Setting, and Participants This retrospective cohort study used deidentified administrative claims data for US adults with diabetes enrolled in employer-sponsored health plans between January 1, 2010, and December 31, 2019. Data analysis was performed from May 26, 2022, to January 2, 2024. Exposures Adults with a baseline year of non-HDHP enrollment who had to switch to an HDHP because their employer offered no non-HDHP alternative in that year were compared with adults who were continuously enrolled in a non-HDHP. Main Outcomes and Measures Mixed-effects logistic regression models examined the association between switching to an HDHP and, individually, the odds of myocardial infarction, stroke, hospitalization for heart failure, lower-extremity complication, end-stage kidney disease, proliferative retinopathy, treatment for retinopathy, and blindness. Models were adjusted for demographics, comorbidities, and medications, with inverse propensity score weighting used to account for potential selection bias. Results The study included 42 326 adults who switched to an HDHP (mean [SD] age, 52 [10] years; 19 752 [46.7%] female) and 202 729 adults who did not switch (mean [SD] age, 53 [10] years; 89 828 [44.3%] female). Those who switched to an HDHP had greater odds of experiencing all diabetes complications (odds ratio [OR], 1.11; 95% CI, 1.06-1.16 for myocardial infarction; OR, 1.15; 95% CI, 1.09-1.21 for stroke; OR, 1.35; 95% CI, 1.30-1.41 for hospitalization for heart failure; OR, 2.53; 95% CI, 2.38-2.70 for end-stage kidney disease; OR, 2.23; 95% CI, 2.17-2.29 for lower-extremity complication; OR, 1.17; 95% CI, 1.13-1.21 for proliferative retinopathy; OR, 2.35; 95% CI, 2.18-2.54 for blindness; and OR, 2.28; 95% CI, 2.15-2.41 for retinopathy treatment). Conclusions and Relevance This study found that an employer-driven switch to an HDHP was associated with increased odds of experiencing all diabetes complications. These findings reinforce the potential harm associated with HDHPs for people with diabetes and the importance of affordable and accessible chronic disease management, which is hindered by high out-of-pocket costs incurred by HDHPs.
Collapse
Affiliation(s)
- Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore
- University of Maryland Institute for Health Computing, Bethesda
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park
- OptumLabs, Eden Prairie, Minnesota
| | - Kavya S. Swarna
- OptumLabs, Eden Prairie, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Holly K. Van Houten
- OptumLabs, Eden Prairie, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park
| | - Esa M. Davis
- University of Maryland Institute for Health Computing, Bethesda
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
2
|
Kaufman M, McConnell KJ, Rodriguez MI, Stratton K, Richardson D, Snowden JM. Hospital Encounters Within 1 Year Postpartum Across Insurance Types, Oregon 2012-2017. Med Care 2024; 62:109-116. [PMID: 38109156 DOI: 10.1097/mlr.0000000000001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Little is known about the timing and frequency of postpartum hospital encounters and postpartum visit attendance and how they may be associated with insurance types. Research on health insurance and its association with postpartum care utilization is often limited to the first 6 weeks. OBJECTIVE To assess whether postpartum utilization (hospital encounters within 1 year postpartum and postpartum visit attendance within 12 weeks) differs by insurance type at birth (Medicaid, high deductible health plans, and other commercial plans) and whether rates of hospital encounters differ by postpartum visit attendance and insurance status. METHODS Time-to-event analysis of Oregon hospital births from 2012 to 2017 using All Payer All Claims data. We conducted weighted Cox Proportional Hazard regressions and accounted for differences in insurance type at birth using multinomial propensity scores. RESULTS Among 202,167 hospital births, 24.9% of births had at least 1 hospital encounter within 1 year postpartum. Births funded by Medicaid had a higher risk of a postpartum emergency department (ED) visit (hazard ratio: 2.05, 95% CI: 1.99, 2.12) and lower postpartum visit attendance (hazard ratio: 0.71, 95% CI: 0.70, 0.72) compared with commercial plans. Among Medicaid beneficiaries, missing the postpartum visit in the first 6 weeks was associated with a lower risk of subsequent readmissions (adjusted hazard ratio 0.77, 95% CI: 0.68, 0.87) and ED visits (adjusted hazard ratio: 0.87 (0.85, 0.88). CONCLUSIONS Medicaid beneficiaries received more care in the ED within 1 year postpartum compared with those enrolled in other commercial plans. This highlights potential issues in postpartum care access.
Collapse
Affiliation(s)
- Menolly Kaufman
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - Maria I Rodriguez
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Kalera Stratton
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
| | - Dawn Richardson
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| |
Collapse
|
3
|
Hager K, Emanuel E, Mozaffarian D. Employer-Sponsored Health Insurance Premium Cost Growth and Its Association With Earnings Inequality Among US Families. JAMA Netw Open 2024; 7:e2351644. [PMID: 38227313 PMCID: PMC10792464 DOI: 10.1001/jamanetworkopen.2023.51644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024] Open
Abstract
Importance Costs of employer-sponsored health care benefits have increased faster than workers' wages for several decades, with important implications for disparities in earnings and wage stagnation. Objective To quantify how growth in employer-sponsored health insurance (ESI) premiums may have been associated with reduced annual wages, disparities in earnings by race and ethnicity and wage level, and wage stagnation among US families with ESI. Design, Setting, and Participants In this economic evaluation, serial cross-sectional analyses were performed of US families receiving ESI from 1988 to 2019 based on data from the Consumer Expenditure Survey, Kaiser Employer Health Benefits Survey, US Census Bureau's Current Population Survey, and federal payroll taxation rates. Statistical analysis was conducted from February 2022 to July 2023. Main Outcomes and Measures Percentage of annual compensation associated with health care premiums (after accounting for tax deductibility) and lost wages associated with growth in cost of premiums from 1989 to 2019 based on 1988 compensation. To assess disparities, analyses were stratified by race and ethnicity and wage level. Results In 1988, 44.7 million individuals (head of household: mean [SD] age, 43.3 [13.1] years; 30.1% were female; and 2.4% identified as Asian, 6.2% as Hispanic, 8.6% as non-Hispanic Black, and 82.8% as non-Hispanic White) were covered by ESI family plans; this number remained similar in 2019 at 44.8 million individuals (head of household: mean [SD] age, 47.1 [12.9] years; 41.3% were female; and 1.3% identified as Asian, 9.9% as Hispanic, 9.9% as non-Hispanic Black, and 78.9% as non-Hispanic White). In 1988, the mean (SD) household size was 3.3 (1.3) people, and in 2019, it was 3.4 (1.3) people. If ESI costs had remained at the same proportion of the 1988 average compensation package, then in 2019, the median US family with ESI could have earned $8774 (95% CI, $8354-$9195) more in annual wages. During all 32 years, health care premiums as a percentage of compensation were greater for non-Hispanic Black and Hispanic families than for non-Hispanic White families. By 2019, 13.8% (95% CI, 13.5%-14.1%) of compensation among non-Hispanic White families with ESI went to premium costs compared with 19.2% (95% CI, 18.8%-19.7%) among non-Hispanic Black families and 19.8% (19.3%-20.3%) among Hispanic families with ESI. In 2019, health care premiums as a percentage of compensation at the 95th percentile of earnings for families with ESI were 3.9% (95% CI, 3.8%-4.0%) compared with 28.5% (95% CI, 27.8%-29.2%) at the 20th percentile of earnings. From 1988 to 2019, the mean cumulative lost earnings associated with growth in health care premiums for the median US family with ESI was $125 340 (95% CI, $120 155-$130 525) in 2019 dollars, 4.7% of earnings over the 32-year period. Conclusions and Relevance This economic evaluation of US families receiving ESI suggests that 3 decades of increasing health care premiums were likely associated with reduced annual earnings and increased earnings inequality by race and ethnicity and wage level and were meaningfully associated with wage stagnation.
Collapse
Affiliation(s)
- Kurt Hager
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
- Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Ezekiel Emanuel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Wharton School, University of Pennsylvania, Philadelphia
| | - Dariush Mozaffarian
- Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| |
Collapse
|
4
|
Ravi M, Safeek R, Zhuang T, Shapiro L, Neal D, Satteson E. The Influence of Out-of-Pocket Cost on Wrist Fracture Treatment Selection. J Hand Surg Am 2023; 48:886-895. [PMID: 37422754 DOI: 10.1016/j.jhsa.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Patient-centered care prioritizes patients' specific health needs and desired outcomes based on their preferences, values, and goals. The aim of this study was to evaluate nonclinical factors that affect decision-making related to wrist fracture treatment options. METHODS A discrete choice experiment was administered via Amazon Mechanical Turk. Participants chose between two treatment options for theoretical wrist fractures. Each choice set contained three levels for four attributes-total out-of-pocket cost, length of cast immobilization, time to return to work, and number of posttreatment follow-up visits-determined using Medicare national average out-of-pocket costs and a range of standard treatment options. Financial stress was evaluated using the InCharge Financial Distress/Financial Well-Being Scale. RESULTS A total of 232 responses were collected. The average financial stress score was 6.29 (SD, 1.97), with 22% (52/232) being classified as financially distressed (score < 5.00). Twenty-eight percent of the participants (n = 64) always chose the lowest cost option, and two participants (0.01%) always chose less time in a cast. Over one-third of the participants chose the cheaper monetary option 80% of the time or more. The odds of choosing a lower cost option were 1.06 times greater per $100 decrease in cost in the entire cohort and 1.03 times greater among 166 participants who did not always choose the least expensive option. In monetary terms, relative importance showed that the participants were willing to pay $19.48 and $58.37 for a week less of cast immobilization and out of work, respectively. CONCLUSIONS This study demonstrates the important role that out-of-pocket cost plays in decision-making compared with the nonclinical components of two equivalent treatment options. CLINICAL RELEVANCE Providers should be cognizant of the cost associated with treatment options so that information on treatment cost can be incorporated into counseling and shared decision-making with patients undergoing hand surgery.
Collapse
Affiliation(s)
- Meena Ravi
- College of Medicine, University of Florida, Gainesville, FL
| | - Rachel Safeek
- Division of Plastic Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Thompson Zhuang
- Department of Orthopeadic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Lauren Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
| | - Dan Neal
- Department of Surgery, University of Florida, Gainesville, FL
| | - Ellen Satteson
- Division of Plastic Surgery, Department of Surgery, University of Florida, Gainesville, FL.
| |
Collapse
|
5
|
Liang MI, Harrison R, Aviki EM, Esselen KM, Nitecki R, Meyer L. Financial toxicity: A practical review for gynecologic oncology teams to understand and address patient-level financial burdens. Gynecol Oncol 2023; 170:317-327. [PMID: 36758422 DOI: 10.1016/j.ygyno.2023.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
Financial toxicity describes the adverse impact patients experience from the monetary and time costs of cancer care. The financial burden patients experience comes from substantially increased out-of-pocket spending that often occurs concurrent with reduced income due to sick leave from work. Financial toxicity is common affecting approximately half of patients with a gynecological cancer depending on the validated instrument used for measurement. Financial toxicity is experienced by patients in three domains: economic hardship affecting patients' material conditions (i.e., medical debt), psychological response (i.e., distress), and health-related coping behaviors that patients adopt (i.e., foregoing care due to costs). Higher financial toxicity among cancer patients has been associated with decreased quality of life, impaired adherence to recommended care, and worse overall survival. In this review, we describe the current literature on financial toxicity, including how it can be assessed with validated tools, the downstream impact on patients, risk factors, and employment concerns of survivors. Whenever possible, we highlight data from research featuring patients with gynecologic cancer specifically. We also review studies with interventions aimed to mitigate financial toxicity and offer the reader real world examples of interventions currently being used. Lastly, we provide an overview of health policy developments relevant to financial toxicity and advocate for innovation in the development and implementation of strategies to decrease the financial toxicity patients experience following a diagnosis of gynecologic cancer.
Collapse
Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Ross Harrison
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katharine M Esselen
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larissa Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
6
|
Wray CM, Lopez L, Khare M, Keyhani S. Cost-Related Access Barriers, Medical Debt, and Dissatisfaction with Care Among Privately Insured Americans. J Gen Intern Med 2023; 38:938-945. [PMID: 36167955 PMCID: PMC10039217 DOI: 10.1007/s11606-022-07822-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Understanding experiences with private important to improving the quality of health care coverage. OBJECTIVE To examine the association of health with cost-related access barriers, medical debt, and dissatisfaction with care among privately insured Americans. DESIGN We classified Americans with private insurance by self-reported health status into five groups (excellent, very good, good, fair, and poor health). We examined self-reported difficulty seeing a doctor due to costs, not taking medications due to costs, medical debt, and dissatisfaction with care among individuals with differing health status. We used logistic regression to examine the association of health status with individuals' experiences after accounting for baseline characteristics. The analysis was repeated among individuals with different forms of private insurance. Odds ratios were converted to risk ratios to improve ease of interpretation of the results. SETTING Behavioral Risk Factor Surveillance System of Americans in 17 states RESULTS: The sample included 82,494 US adults with private insurance. Following adjustment, compared to individuals with excellent health those in very good health, good health, fair health, and poor health reported increasingly higher risks of difficulty seeing a doctor due to costs with risk ratios of 1.02 (95% CI 1.01, 1.03), 1.07 (95% CI 1.06, 1.08), 1.18 (95% CI 1.17, 1.20), and 1.29 (95% CI 1.27, 1.31), respectively. Compared to individuals with excellent health, those in very good health, good health, fair health, and poor health reported increasingly higher risks of not taking medication due to costs, outstanding medical debt, and dissatisfaction with care. Similar relationships were seen across individually purchased and employer-sponsored insurance. CONCLUSION Cost-related access barriers, medical debt, and dissatisfaction with care were common among individuals with private insurance and most pronounced among those with fair and poor health who likely need and use their health insurance the most.
Collapse
Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, San Francisco, USA.
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, USA.
| | - Lenny Lopez
- Department of Medicine, University of California, San Francisco, San Francisco, USA
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, USA
| | - Meena Khare
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco, USA
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, San Francisco, USA
- Section of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, USA
| |
Collapse
|
7
|
Mattingly TJ, Everson J, Besaw RJ, Whitmore CC, Henderson SC, Dusetzina SB. "Worth it if you could afford it": Patient perspectives on integrating real-time benefit tools into drug cost conversations. J Am Geriatr Soc 2023; 71:1627-1637. [PMID: 36637794 DOI: 10.1111/jgs.18226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Medication costs can lead to financial burdens for patients, creating barriers to effective medication use. Health care provider use of real-time benefit tools (RTBTs) may facilitate cost conversations with patients. We sought to explicate patient views on how RTBTs could be used to improve cost considerations in prescribing decisions. METHODS We conducted focus groups to characterize patient perspectives on holding cost conversations with their physicians and to identify factors that would influence the value of RTBTs. We focused on adults aged 50+ who reported trouble paying for their prescriptions. Three groups included patients with conditions requiring high-cost treatments and one group included lower-income patients independent of their medical conditions. Focus groups were recorded, transcribed, coded, and categorized to salient themes employing inductive and deductive approaches using the Health Equity Implementation Framework. RESULTS Focus groups were conducted from 09/2020-12/2020 including 18 participants representing cancer (n = 6), diabetes (n = 6), rheumatoid arthritis (n = 3), and lower income (n = 3). Participants were between 50-74, eight self-identified as Black, 10 as White, and eight reported earning <$50,000/year. We identified five themes regarding cost conversations (medication cost importance, past experiences with cost/cost conversations, perception of physician's role and knowledge, knowledge of existing resources, and influence on decision-making) and four RTBT-use-specific themes (advantages/disadvantages, perceived relevance, data quality concerns, and implementation considerations). CONCLUSION Approaches that envision RTBTs as one-size-fits-all technological interventions may underestimate the complexity of incorporating price information into prescribing decisions. Nevertheless, patients highlighted the potential value of accurate, real-time information on medication costs to inform decision-making.
Collapse
Affiliation(s)
- T Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Jordan Everson
- Department of Health and Human Services, Data Analysis Branch, Office of the National Coordinator for Health Information Technology, Washington, District of Columbia, USA
| | - Robert J Besaw
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Christine C Whitmore
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sarah C Henderson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| |
Collapse
|
8
|
Michaud JB, Zhuang T, Shapiro LM, Cohen SA, Kamal RN. Out-of-Pocket and Total Costs for Common Hand Procedures From 2008 to 2016: A Nationwide Claims Database Analysis. J Hand Surg Am 2022; 47:1057-1067. [PMID: 35985865 DOI: 10.1016/j.jhsa.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Rising patient out-of-pocket (OOP) costs and financial distress have been associated with reduced access to and delays in care. We evaluated whether OOP and total costs for common hand procedures have increased from 2008 to 2016 and identified key drivers of these costs. METHODS Using the IBM MarketScan Research Databases, we identified patients who underwent trigger finger release, open carpal tunnel release, thumb carpometacarpal joint arthroplasty, cubital tunnel release, or open treatment of distal radius fracture in the outpatient setting between 2008 and 2016. Patient OOP costs included copayment, coinsurance, and deductible payments. Costs not directly related to medical care, such as transportation and childcare costs, were not included. The overall cost was defined as the sum of the patient OOP cost and insurer reimbursements. We calculated changes in OOP and total overall costs over the study period. We also performed multivariable linear regressions to evaluate the associations between costs and procedure type, insurance type, region, and site of service. RESULTS The mean patient OOP cost increased by 55% to 71% and the total overall cost increased by 20% to 45%, depending on the procedure, between 2008 and 2016. Facility overall costs increased by 38%, whereas professional overall costs increased by 9%. Procedures performed in an office-based setting were associated with the lowest patient OOP and total overall costs, whereas high-deductible health plans were associated with the highest OOP costs. CONCLUSIONS Patient OOP and total overall costs increased for the most common hand procedures between 2008 and 2016, driven by a substantial increase in facility costs. Office-based procedures were associated with the lowest costs. CLINICAL RELEVANCE To alleviate the rising patient cost burden, hand surgeons could incorporate OOP cost considerations into shared decision-making tools, identify patients who may benefit from financial counseling, and shift procedures to an office-based setting.
Collapse
Affiliation(s)
- John B Michaud
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Thompson Zhuang
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA
| | - Samuel A Cohen
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
| |
Collapse
|
9
|
Yu J, Perrin JM, Hagerman T, Houtrow AJ. Underinsurance Among Children in the United States. Pediatrics 2022; 149:183780. [PMID: 34866156 PMCID: PMC9647940 DOI: 10.1542/peds.2021-050353] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES We describe the change in the percentage of children lacking continuous and adequate health insurance (underinsurance) from 2016 to 2019. We also examine the relationships between child health complexity and insurance type with underinsurance. METHODS Secondary analysis of US children in the National Survey of Children's Health combined 2016-2019 dataset who had continuous and adequate health insurance. We calculated differences in point estimates, with 95% confidence intervals (CIs), to describe changes in our outcomes over the study period. We used multivariable logistic regression adjusted for sociodemographic characteristics and examined relationships between child health complexity and insurance type with underinsurance. RESULTS From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0% (+3.4%; 95% CI, +1.9% to +4.9%), an additional 2.4 million children. This trend was driven by rising insurance inadequacy (24.8% to 27.9% [+3.1%; 95% CI, +1.7% to +4.5%]), which was mainly experienced as unreasonable out-of-pocket medical expenses. Although the estimate of children lacking continuous insurance coverage rose from 8.1% to 8.7% (+0.6%), it was not significant at the 95% CI (-0.5% to +1.7%). We observed significant growth in underinsurance among White and multiracial children, children living in households with income ≥200% of the federal poverty limit, and those with private health insurance. Increased child health complexity and private insurance were significantly associated with experiencing underinsurance (adjusted odds ratio, 1.9 and 3.5, respectively). CONCLUSIONS Underinsurance is increasing among US children because of rising inadequacy. Reforms to the child health insurance system are necessary to curb this problem.
Collapse
Affiliation(s)
- Justin Yu
- Departments of Pediatrics,Address correspondence to Justin Yu, MD, MS, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Faculty Pavilion, Suite 3110, 4401 Penn Ave, Pittsburgh, PA, 15224. E-mail:
| | - James M. Perrin
- Department of Pediatrics, Harvard Medical School and MassGeneral Hospital for Children, Boston, Massachusetts
| | - Thomas Hagerman
- Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
| | - Amy J. Houtrow
- Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
Matros E, Offodile AC. Financial Toxicity Following Post-Mastectomy Reconstruction: Consideration for a Novel Outcome Measure. Ann Surg Oncol 2022; 29:25-27. [PMID: 34528178 PMCID: PMC8956933 DOI: 10.1245/s10434-021-10792-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Evan Matros
- Section of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anaeze C. Offodile
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX,Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX,Baker Institute for Public Policy, Rice University, Houston, TX
| |
Collapse
|
11
|
Alnijadi AA, Li M, Wu J, Xiong X, Lu ZK. Trend and effects of high-deductible health insurance plans in the health care system: financial access problems in management of cognitive impairment. J Manag Care Spec Pharm 2021; 28:7-15. [PMID: 34949113 PMCID: PMC10372991 DOI: 10.18553/jmcp.2022.28.1.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: High-deductible health plans (HDHPs) are characterized by higher deductibles and lower monthly premiums compared with a typical health plan. HDHPs may reduce, or delay, needed care, which will ultimately lead to poorer access to care for chronically affected participants. OBJECTIVES: To (1) investigate the HDHP enrollment trend and (2) determine the effects of HDHPs on financial access problems for individuals with self-reported cognitive impairment. METHODS: Data between 2010 and 2018 were obtained from the National Health Interview Survey (NHIS). Individuals with cognitive impairment were identified if they were limited by memory difficulties. Problems regarding financial access to health care were assessed based on 6 survey questions from the Centers for Disease Control and Prevention. Multivariable logistic regressions were implemented to evaluate the effects of HDHPs. RESULTS: This study identified 1,148 individuals with cognitive impairment, representing 3.9 million individuals in the United States from 2010 to 2018. A nearly 2-fold increase in HDHP enrollment with cognitive impairment was observed from 2010 (20.9%) to 2018 (41.9%). This increase is similar to that reported for noncognitively impaired individuals. After controlling for possible confounding variables, cognitively impaired individuals with HDPHs were more likely to have overall financial access difficulties compared with those without HDHPs (OR = 1.17, 95% CI = 0.88-1.56, P = 0.271), but this likelihood was not statistically significant. CONCLUSIONS: HDHPs are intended to support effective care options and reduce health care costs. However, our research found that among individuals with cognitive impairment, those with HDHPs experienced some financial access problems, such as affording medical care, follow-up care, and specialists, than those without HDHPs, indicating that HDHPs might have unintended consequences for health care usage. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest or financial interests to disclose.
Collapse
Affiliation(s)
- Abdulrahman A Alnijadi
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, and Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College, Clinton, SC
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia
| | - Z Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia
| |
Collapse
|
12
|
Larson K, Gottschlich EA, Cull WL, Olson LM. High-Deductible Health Plans for US Children: Trends, Health Service Use, and Financial Barriers to Care. Acad Pediatr 2021; 21:1345-1354. [PMID: 33713837 DOI: 10.1016/j.acap.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/08/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Few studies have examined children's enrollment in high-deductible health plans (HDHPs) and associations with health service use. We examine trends, health service use, and financial barriers to care for US children with high-deductible private insurance. METHODS Trend data on HDHP enrollment were available for 58,910 children ages 0 to 17 with private insurance from the 2007 to 2018 National Health Interview Survey. Health service indicators were examined in a cross-sectional sample of 23,959 children in the 2014-2018 datasets. High deductible was defined as a minimum of $2,700 for a family in 2018. Chi-square tests examined associations of HDHPs with health service indicators. Logistic regression models adjusted for sociodemographics and child health. RESULTS The percent of privately insured children with HDHPs increased from 18.4% to 48.6% from 2007 to 2018. In adjusted regression, those with HDHPs fared worse than those with traditional plans on 7 of 10 measures and those with HDHPs and no health savings account (HSA) fared worse on eight. While small differences were found for various child-focused measures, the most consistent differences were found for family-focused measures. Parents with HDHPs were more likely than parents with traditional private insurance to report they had delayed or forgone their medical care (10.2% vs 5.7%), had problems paying medical bills (15.7% vs 10.3%), and had family medical debt (34.1% vs 25.8%). CONCLUSIONS Privately insured families have seen substantial growth in high-deductible plans in the last decade. Families with HDHPs, especially those without HSAs, have more financial barriers to care.
Collapse
|
13
|
Sinaiko AD, Gaye M, Wu AC, Bambury E, Zhang F, Xu X, Wharam JF, Galbraith AA. Out-of-Pocket Spending for Asthma-Related Care Among Commercially Insured Patients, 2004-2016. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4324-4331.e7. [PMID: 34481128 DOI: 10.1016/j.jaip.2021.07.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Out-of-pocket (OOP) health care costs can cause financial burden and deferred care for many Americans. Little is known about OOP spending for asthma-related care among the commercially insured. OBJECTIVES To analyze OOP spending for asthma-related care overall, across types of care, and by income. METHODS Using enrollment, claims, and geocoded census tract data on income from a large US commercial health plan from 2004 to 2016, we measured inflation-adjusted OOP spending for individuals with asthma ages 4 to 64 years (n = 1,986,769). We estimated annual asthma-related OOP spending over time, and average total, asthma-related, asthma type of care, and asthma medication spending by income. We measured trends in median OOP cost per medication. Linear regression models were adjusted for patient covariates and deductible level. RESULTS Asthma-related OOP spending decreased over time both for patients enrolled in high-deductible health plans and for those in traditional plans. High-deductible plan enrollment increased from 7% to 54%. Compared with patients living in high-income areas, patients in the lowest-income areas had similar annual total and asthma-related OOP spending, but spent 30% less on controller medications and a higher proportion of their asthma-related OOP spending on inpatient and emergency care (10% vs 3%; P < .001). Asthma-related OOP spending represented a higher proportion of household income for patients in lower-income areas. CONCLUSIONS Patients with asthma living in the lowest-income areas have greater cost burden, lower spending on controller medications, and greater spending on high-acuity care than higher-income counterparts.
Collapse
Affiliation(s)
- Anna D Sinaiko
- Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Marema Gaye
- Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | | | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Xin Xu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Alison A Galbraith
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| |
Collapse
|
14
|
Mahashabde R, Li C. Nonelderly Adult Cancer Survivors in High Deductible Health Plan: Healthcare Expenditure, Utilization and Access. Healthcare (Basel) 2021; 9:1090. [PMID: 34574864 PMCID: PMC8470928 DOI: 10.3390/healthcare9091090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: To compare healthcare expenditure, utilization and access between nonelderly adult cancer survivors enrolled in a high deductible health plan with a health savings account ("HDHP+HSA"), HDHP without HSA ("HDHP alone") and low deductible health plan ("LDHP"). Methods: 1735 cancer survivors, aged 18-64 years, with continuous private coverage identified from the 2012-2017 Medical Expenditure Panel Survey: HDHP alone (n = 353), HDHP+HSA (n = 242) and LDHP (n = 1140). Healthcare expenditures, utilization and inability/delay obtaining medical care were analyzed using generalized linear regressions with inverse propensity score weighting and doubly robust estimation. Results: HDHP alone group (23,255 USD) had significantly higher total healthcare expenditure compared to HDHP+HSA (15,580 USD, p = 0.012) and LDHP (16,261 USD, p = 0.016). HDHP alone (6089 USD; p = 0.002) and HDHP+HSA (5743 USD; p = 0.012) groups had significantly higher out-of-pocket (OOP) expenditure compared to LDHP (4853 USD). HDHP alone (17,128 USD, p = 0.010) and LDHP (12,645 USD, p = 0.045) had significantly higher private insurer payments compared to HDHP+HSA (9216 USD). No differences were found in utilization or inability/delay obtaining medical care across groups. Conclusions: Non-elderly adult cancer survivors with continuous coverage and comparable sociodemographic characteristics enrolled in HDHP with HSA displayed the lowest healthcare costs compared to HDHP without HSA and LDHP. HDHP+HSA had a significantly higher OOP expenditure than LDHP. No significant differences were observed in utilization or access among groups.
Collapse
Affiliation(s)
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| |
Collapse
|
15
|
Ortiz SE, Segel JE, Tran LM. Health Savings Plans and Disparities in Access to Care by Race and Ethnicity. Am J Prev Med 2021; 61:e81-e92. [PMID: 33985836 DOI: 10.1016/j.amepre.2021.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION High-deductible health plans are often touted to motivate patients to become informed healthcare purchasers; however, racial/ethnic minorities report that high deductibles prevent them from seeking the needed care. One proposed way to mitigate the financial burden of high-deductible health plans is the use of health savings plans. This cross-sectional study investigates whether chronically ill Blacks and Hispanics enrolled in high-deductible health plans experience greater access to care difficulties than non-Hispanic Whites and whether racial/ethnic disparities are mitigated by the use of health savings plans. METHODS Weighted, multivariate, linear probability regression models were estimated (analyses were conducted in December 2020), adjusting for individual attributes and contextual factors that may explain the variation in health care access. Chronically ill, U.S.-born Black, Hispanic, and White adults enrolled in a high-deductible health plan from the National Health Interview Survey in 2011-2018 were included. Associations were tested among 3 independent variables-being Black, being Hispanic, and health savings plan utilization (and their interaction)-and access to healthcare outcomes of interest, including affordability-related access, provider-related access, and delayed care. RESULTS Blacks and Hispanics were less likely to use health savings plans, and Blacks were more likely to experience problems with access to health care. Although the use of health savings plans was found to have a minimal effect on reducing racial/ethnic disparities in affordability-related access, there was also evidence that health savings plans compounded racial/ethnic disparities in provider-related access. CONCLUSIONS Understanding how health savings plans function to improve access to care within racial/ethnic minority groups may help to inform policy approaches related to their use.
Collapse
Affiliation(s)
- Selena E Ortiz
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania.
| | - Joel E Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania
| | - Linh M Tran
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
16
|
Pan IW, Oeffinger KC, Shih YCT. Cost-Sharing and Out-of-Pocket Cost for Women Who Received MRI for Breast Cancer Screening. J Natl Cancer Inst 2021; 114:254-262. [PMID: 34320199 DOI: 10.1093/jnci/djab150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The financial protection of the Affordable Care Act's (ACA) prevention provision doesn't apply to breast MRI but only to mammography for breast cancer screening. The purpose of the study is to examine the financial burden among women who received breast MRI for screening. METHODS This observational study used the Marketscan® database. Women underwent breast MRI between 2009 and 2017 and had screening mammography within 6 months of the MRI were included. We compared the time trend of the proportion of zero cost-share for women undergoing screening mammography and that for MRI. We quantified out-of-pocket (OOP) costs as the sum of copayment, coinsurance, and deductible and defined zero cost-share as having no OOP cost. We conducted multivariable logistic regression and two-part model to examine factors associated with zero cost-share and OOP costs of MRI, respectively. RESULTS 16,341 women had a screening breast MRI during the study period. The proportion of screening MRI claims with zero cost-share decreased from 43.1% (2009) to 26.2% (2017). The adjusted mean OOP cost for women in high-deductible plans was more than twice the cost for their counterparts ($549 vs. $251, 2-sided P < .001). Women who resided in the South in the post-ACA era were less likely to have zero cost-share and paid higher OOP costs for screening MRI. CONCLUSIONS Many women are subject to high financial burden when receiving MRI for breast cancer screening. Those enrolled in high-deductible plans and who reside in the South are especially vulnerable financially.
Collapse
Affiliation(s)
- I-Wen Pan
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
17
|
Butler AJ, Granger CJ, Rivera S, Donnally CJ, Ghasem A, Li D, Wang MY. Availability and Variability of Consumer Prices for Lumbar Discectomy Across US Hospitals in 2018. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:81-96. [PMID: 32495066 DOI: 10.1007/s40258-020-00592-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine the availability and variability of consumer pricing data for an elective lumbar discectomy in the USA. METHODS Hospital representatives were contacted via telephone, hospital websites, and state price-transparency websites. A total of 153 hospitals were contacted via telephone calls under the guise of a patient requesting a self-pay price for elective lumbar discectomy. The same hospitals were then researched for price comparison between those requested by phone and those listed on hospital websites after installment of the price transparency law by the Centers of Medicare and Medicaid Services (CMS) on 1 January 2019. Complete and partial prices were recorded for both datasets when available. Hospitals were grouped based on profit status, teaching status, and geographical region. Statistical analysis compared rates of price availability and mean prices between hospital groups and between datasets. RESULTS Thirty-four (23.0%) of 148 hospitals included in the final analysis were able to provide complete price information via telephone. An additional 70 (47.3%) were able to provide a partial price. A total of four (2.7%) institutions provided a complete price and an additional 65 (43.9%) provided a partial price via website. The mean complete price for microdiscectomy when provided was $27,342.36 (n = 34). When compared to government and non-profit hospitals combined, private hospitals had significantly lower partial-prices. CONCLUSION A patient seeking to undergo a common surgical procedure in the USA will likely be met with difficulty and few options if motivated by price. A high degree of variability exists among US hospitals in 2018 with regards to availability and comprehensiveness of pricing information.
Collapse
Affiliation(s)
- Alexander J Butler
- Department of Orthopedic Surgery, University of Miami Hospital, 1400 N.W. 12th Ave, Miami, FL, 33136, USA.
| | - Caroline J Granger
- University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Sebastian Rivera
- Department of Orthopedic Surgery, University of Miami Hospital, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Chester J Donnally
- Rothman Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander Ghasem
- Emory Orthopedics and Spine Center, 59 Executive Park S, Atlanta, GA, 30329, USA
| | - Deborah Li
- University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1475 NW 12th St, 1st Floor, Miami, FL, 33136, USA
| |
Collapse
|
18
|
Khera R, Valero-Elizondo J, Nasir K. Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions. J Am Heart Assoc 2020; 9:e017793. [PMID: 32924728 PMCID: PMC7792407 DOI: 10.1161/jaha.120.017793] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) has posed an increasing burden on Americans and the United States healthcare system for decades. In addition, ASCVD has had a substantial economic impact, with national expenditures for ASCVD projected to increase by over 2.5‐fold from 2015 to 2035. This rapid increase in costs associated with health care for ASCVD has consequences for payers, healthcare providers, and patients. The issues to patients are particularly relevant in recent years, with a growing trend of shifting costs of treatment expenses to patients in various forms, such as high deductibles, copays, and coinsurance. Therefore, the issue of “financial toxicity” of health care is gaining significant attention. The term encapsulates the deleterious impact of healthcare expenditures for patients. This includes the economic burden posed by healthcare costs, but also the unintended consequences it creates in form of barriers to necessary medical care, quality of life as well tradeoffs related to non‐health–related necessities. While the societal impact of rising costs related to ASCVD management have been actively studied and debated in policy circles, there is lack of a comprehensive assessment of the current literature on the financial impact of cost sharing for ASCVD patients and their families. In this review we systematically describe the scope and domains of financial toxicity, the instruments that measure various facets of healthcare‐related financial toxicity, and accentuating factors and consequences on patient health and well‐being. We further identify avenues and potential solutions for clinicians to apply in medical practice to mitigate the burden and consequences of out‐of‐pocket costs for ASCVD patients and their families.
Collapse
Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| |
Collapse
|
19
|
Bailey CM, Selber J, Liu J, Lee CN, Offodile AC. Current Practice and Perceptions Regarding Cost Communication in Breast Cancer Reconstruction: Survey Results of the American Society of Plastic Surgeons. Ann Surg Oncol 2020; 28:376-385. [PMID: 32613364 DOI: 10.1245/s10434-020-08750-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rising out-of-pocket costs (OOCs) are a major concern for breast cancer survivors. However, information on how plastic surgeons performing breast reconstruction (BR) perceive and communicate cost information is limited. METHODS An electronic, anonymous survey eliciting plastic surgeons' attitudes and behaviors regarding BR cost communication was distributed to active American Society of Plastic Surgery members. Questions were derived from previously published studies and entailed a 5-point Likert scale. Cost communication was identified based on dichotomized responses to the prompt, "I discuss the costs of breast reconstruction with my patients," and analyzed for associated factors. RESULTS Of the 5112 surgeons surveyed, 396 plastic surgeons responded (7.21%). Most of the surgeons reported having a sense of a patient's financial well-being (65%) and an awareness of treatment costs (66.9%). Most felt a responsibility to consider the impact of BR costs (69%). Although most of the surgeons expressed that they were comfortable having OOC discussions (58.9%), only a minority reported doing so routinely (24.2%). The fewest respondents (8.6%) cited OOC as an important variable for BR decision-making. Lack of supportive tools was the most cited barrier to having cost communication with patients (64.8%). Cost communication was identified in a minority (20.2%) of surgeon-patient encounters and had no significant relationship to surgeon demographics or practice setting. CONCLUSIONS Plastic surgeons rarely discuss costs of BR with patients despite having a high awareness of the topic and feeling comfortable with it. Prevailing attitudes about the importance of OOC and the lack of administrative support or cost information are likely the drivers of this mismatch and warrant further study.
Collapse
Affiliation(s)
- Chad M Bailey
- Plastic and Reconstructive Surgeons, Renton, WA, USA
| | - Jesse Selber
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jun Liu
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clara N Lee
- Department of Plastic Surgery, The Ohio State University, Columbus, OH, USA
| | - Anaeze C Offodile
- Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Baker Institute for Public Policy, Rice University, Houston, TX, USA.
| |
Collapse
|
20
|
Crowley R, Daniel H, Cooney TG, Engel LS. Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care. Ann Intern Med 2020; 172:S7-S32. [PMID: 31958805 DOI: 10.7326/m19-2415] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford. Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage. The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Part 2 presents 2 potential approaches, a single-payer model and a public choice model, to achieve universal coverage. Part 3 describes how an emphasis on value-based care can reduce costs.
Collapse
Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C., H.D.)
| | - Hilary Daniel
- American College of Physicians, Washington, DC (R.C., H.D.)
| | - Thomas G Cooney
- Oregon Health & Science University and Portland Veterans Affairs Medical Center, Portland, Oregon (T.G.C.)
| | - Lee S Engel
- Louisiana State University Health Sciences Center, New Orleans, Louisiana (L.S.E.)
| | | |
Collapse
|
21
|
Adamson AS, Pignone MP. Eliminating Copayments for Skin Cancer Screening—A Public Health Policy With Insufficient Evidence. JAMA Dermatol 2019; 155:1339-1340. [DOI: 10.1001/jamadermatol.2019.2797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adewole S. Adamson
- Division of Dermatology, Department of Internal Medicine, LIVESTRONG Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin
| | - Michael P. Pignone
- Department of Internal Medicine, LIVESTRONG Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin
| |
Collapse
|