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Udemgba C, Burbank AJ, Gleeson P, Davis CM, Matsui EC, Mosnaim G. Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00632-9. [PMID: 38878860 DOI: 10.1016/j.jaip.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Addressing patient adherence is a key element in ensuring positive health outcomes and improving health-related quality of life for patients with atopic and immunologic disorders. Understanding the complex etiologies of patient nonadherence and identifying real-world solutions is important for clinicians, patients, and systems to design and effect change. This review serves as an important resource for defining key issues related to patient nonadherence and outlines solutions, resources, knowledge gaps, and advocacy areas across five domains: health care access, financial considerations, socioenvironmental factors, health literacy, and psychosocial factors. To allow for more easily digestible and usable content, we describe solutions based on three macrolevels of focus: patient, clinician, and system. This review and interactive tool kit serve as an educational resource and call to action to improve equitable distribution of resources, institutional policies, patient-centered care, and practice guidelines for improving health outcomes for all patients with atopic and immunologic disorders.
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Affiliation(s)
- Chioma Udemgba
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md; University Medicine Associates, University Health, San Antonio, Tex.
| | - Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Patrick Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Carla M Davis
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Elizabeth C Matsui
- Center for Health & Environment: Education & Research, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Giselle Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Endeavor Health, Glenview, Ill
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2
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Gordon LG, Nabukalu D, Chan RJ, Goldsbury DE, Hobbs K, Hunt L, Karikios DJ, Mackay G, Muir L, Leigh L, Thamm C, Lindsay D, Whittaker K, Varlow M, McLoone J, Financial Toxicity Working Group OBOTC. Opinions and strategies of Australian health professionals on tackling cancer-related financial toxicity: A nationwide survey. Asia Pac J Clin Oncol 2023; 19:126-135. [PMID: 35589922 DOI: 10.1111/ajco.13786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/20/2023]
Abstract
AIM To understand the opinions and current practices of health professionals on the topic of addressing cancer-related financial toxicity among patients. METHODS A cross-sectional online survey was distributed through Australian clinical oncology professional organizations/networks. The multidisciplinary Clinical Oncology Society of Australia Financial Toxicity Working Group developed 25 questions relating to the frequency and comfort levels of patient-clinician discussions, opinions about their role, strategies used, and barriers to providing solutions for patients. Descriptive statistics were used and subgroup analyses were undertaken by occupational groups. RESULTS Two hundred and seventy-seven health professionals completed the survey. The majority were female (n = 213, 77%), worked in public facilities (200, 72%), and treated patients with varied cancer types across all of Australia. Most participants agreed that it was appropriate in their clinical role to discuss financial concerns and 231 (88%) believed that these discussions were an important part of high-quality care. However, 73 (28%) stated that they did not have the appropriate information on support services or resources to facilitate such conversations, differing by occupation group; 7 (11%) social workers, 34 (44%) medical specialists, 18 (25%) nurses, and 14 (27%) of other occupations. Hindrances to discussing financial concerns were insufficient resources or support systems to refer to, followed by lack of time in a typical consultation. CONCLUSION Health professionals in cancer care commonly address the financial concerns of their patients but attitudes differed across occupations about their role, and frustrations were raised about available solutions. Resources supporting financial-related discussions for all health professionals are urgently needed to advance action in this field.
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Affiliation(s)
- Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia.,Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | - Doreen Nabukalu
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - David E Goldsbury
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kim Hobbs
- Oncology Social Work Australia & New Zealand/Westmead Hospital NSW, Westmead, New South Wales, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney NSW, Australia
| | - Deme J Karikios
- Department of Medical Oncology, Nepean Hospital, Kingswood, New South Wales, Australia.,Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Mackay
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Laura Muir
- Cancer Council NSW, Sydney, New South Wales, Australia
| | | | - Carla Thamm
- Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia
| | - Daniel Lindsay
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | | | | | - Jordana McLoone
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital NSW, Sydney, New South Wales, Australia.,Discipline of Paediatrics & Child Health, UNSW Medicine & Health, Randwick Clinical Campus, University of NSW, Sydney, New South Wales, Australia
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3
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Brown T, Apenteng BA, Opoku ST. Factors associated with cost conversations in oral health care settings. J Am Dent Assoc 2022; 153:829-838. [PMID: 35589435 DOI: 10.1016/j.adaj.2022.04.003] [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: 09/15/2021] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patient-provider cost conversations can minimize cost-related barriers to health, while improving treatment adherence and patient satisfaction. The authors sought to identify factors associated with the occurrence of cost conversations in dentistry. METHODS This was a cross-sectional study using data from an online, self-administered survey of US adults who had seen a dentist within the past 24 months at the time of the survey. Multivariable hierarchical logistic regression analysis was used to identify patient and provider characteristics associated with the occurrence of cost conversations. RESULTS Of the 370 respondents, approximately two-thirds (68%) reported having a cost conversation with their dental provider during their last dental visit. Cost conversations were more likely for patients aged 25 through 34 years (odds ratio [OR], 2.84; 95% CI, 1.54 to 5.24), 35 through 44 years (OR, 3.35; 95% CI, 1.50 to 7.51), and 55 through 64 years (OR, 3.39; 95% CI, 1.38 to 8.28) than patients aged 18 through 24 years. Cost conversations were less likely to occur during visits with dental hygienists than during visits with general or family dentists (OR, 0.25; 95% CI, 0.11 to 0.58). In addition, respondents from the South (OR, 1.90; 95% CI, 1.04 to 3.48) and those screened for financial hardship were more likely to report having cost conversations with their dental providers (OR, 6.70; 95% CI, 2.69 to 16.71). CONCLUSIONS Within the study sample, cost conversations were common and were facilitated via financial hardship screening. PRACTICAL IMPLICATIONS Modifying oral health care delivery processes to incorporate financial hardship screening may be an effective way to facilitate cost conversations and provision of patient-centered care.
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Manik R, Carlos RC, Duszak R, Sadigh G. Costs Versus Quality in Imaging Examination Decisions. J Am Coll Radiol 2022; 19:450-459. [PMID: 35122720 DOI: 10.1016/j.jacr.2021.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Emerging price transparency tools allow consumers to access individualized out-of-pocket cost (OOPC) estimates, but many lack quality metrics. The aim of this study was to evaluate how potential patients weigh imaging OOPC versus measures of quality when selecting an imaging center for a hypothetical health condition (back pain). METHODS Surveying 1,310 Amazon Mechanical Turk volunteers, the authors evaluated how potential patients weigh MRI OOPC ($50 vs $400 vs unknown cost at the time of the examination, with billed OOPC responsibility varying between $50 and $3,500) versus service quality surrogates using three different quality indicators (examination results accuracy, physician recommendation of an imaging center on the basis of familiarity, and facility online star ratings) in their decisions when selecting a radiology center for imaging of two hypothetical clinical conditions (mild and severe back pain), using ranking-based conjoint analyses. RESULTS A total of 1,025 eligible respondents completed the survey. Respondents expressed higher preference for perceived quality over cost in hypothetical severe back pain scenarios, resulting in a relative importance of 65.8% (95% confidence interval [CI], 62.2%-69.4%) for improved imaging results accuracy from 87% to 96%, 63.9% (95% CI, 60.3%-67.5%) for provider recommendations of the facility, and 80.1% (95% CI, 74.2%-85.9%) for an increase in online review star ratings from 2.5 to 4.5 (out of 5) compared with an increased cost from $50 to $400. For mild back pain, there was no statistical difference in respondents' preference for perceived quality and cost. CONCLUSIONS Incorporating quality metrics into price transparency tools is important. Further research is needed to identify metrics that are most comparable and easily obtainable across imaging centers that remain important to patients.
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Affiliation(s)
- Ritika Manik
- Emory College of Arts and Sciences, Emory University, Atlanta, Georgia
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
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Herrick CJ, Humble S, Hollar L, Chang SH, Hunleth J, McQueen A, James AS. Cost-Related Medication Non-adherence, Cost Coping Behaviors, and Cost Conversations Among Individuals with and Without Diabetes. J Gen Intern Med 2021; 36:2867-2869. [PMID: 32875495 PMCID: PMC8390723 DOI: 10.1007/s11606-020-06176-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Cynthia J Herrick
- Department of Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Surgery, Division Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA.
| | - Sarah Humble
- Department of Surgery, Division Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Su-Hsin Chang
- Department of Surgery, Division Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean Hunleth
- Department of Surgery, Division Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy McQueen
- Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Aimee S James
- Department of Surgery, Division Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Dickert NW, Mitchell AR, Venechuk GE, Matlock DD, Moore MA, Morris AA, Pierce KJ, Speight CD, Allen LA. Show Me the Money: Patients' Perspectives on a Decision Aid for Sacubitril/Valsartan Addressing Out-of-Pocket Cost. Circ Cardiovasc Qual Outcomes 2020; 13:e007070. [PMID: 33302715 PMCID: PMC7738420 DOI: 10.1161/circoutcomes.120.007070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Out-of-pocket medication costs for patients who have heart failure with reduced ejection fraction may be an important part of shared decision-making, but cost has generally been excluded from clinical discussions. This study reports patients' perspectives on a decision aid for sacubitril/valsartan that explicitly addresses out-of-pocket costs. METHODS Structured, in-depth interviews were conducted with 20 patients with heart failure with reduced ejection fraction from 2 medical centers to elicit their views on a publicly available decision aid for sacubitril/valsartan that explicitly incorporates considerations related to out-of-pocket costs. Qualitative descriptive analysis was conducted. RESULTS Key themes identified were general enthusiasm for decision aids for medication decisions, openness on the part of patients to incorporation of cost into decision-making and the decision aid, requests for greater specificity regarding patient-specific cost, and challenges communicating evidence of benefit in a way that allows patients to make cost-benefit analyses for themselves. Patients also raised questions regarding logistical challenges of incorporating a decision aid into the normal clinical and decision-making workflow. CONCLUSIONS Patients were receptive to the inclusion of out-of-pocket cost as relevant in a decision aid for sacubitril/valsartan. Key challenges to effective integration of cost in these decisions include developing mechanisms for acquiring reliable patient-specific cost estimates and addressing patients' difficulties (and sometimes skepticism) applying trial evidence to their own situation. In addition, implementation strategies are important to develop to facilitate decision aid integration for routine medical decisions into clinic workflow.
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Affiliation(s)
- Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.).,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.W.D.).,Emory Center for Ethics, Atlanta, GA (N.W.D.)
| | - Andrea R Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.)
| | - Grace E Venechuk
- Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora.,Center for Demography of Health and Aging, University of Wisconsin-Madison (G.E.V.)
| | - Daniel D Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora.,Division of Geriatric Medicine (D.D.M.), University of Colorado School of Medicine, Aurora.,Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver (D.D.M.)
| | - Miranda A Moore
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA (M.A.M.)
| | - Alanna A Morris
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.)
| | - Kenneth J Pierce
- Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora
| | - Candace D Speight
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, ECCRI, Atlanta, GA (N.W.D., A.R.M., A.A.M., C.D.S.)
| | - Larry A Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science (G.E.V., D.D.M., K.J.P., L.A.A.), University of Colorado School of Medicine, Aurora.,Division of Cardiology (L.A.A.), University of Colorado School of Medicine, Aurora
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7
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Rao BR, Dickert NW, Morris AA, Speight CD, Smith GH, Shore S, Moore MA. Heart Failure and Shared Decision-Making: Patients Open to Medication-Related Cost Discussions. Circ Heart Fail 2020; 13:e007094. [PMID: 33176459 DOI: 10.1161/circheartfailure.120.007094] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Discussions of medication costs between patients and clinicians are infrequent and often suboptimal. In the context of recently introduced drugs that are effective but expensive, patients with heart failure with reduced ejection fraction provide an ideal population to understand the perspectives of patients with chronic illness on medication cost and cost discussions. METHODS To explore patients' perspectives on discussing out-of-pocket medication costs with clinicians, 49 adults, aged 44 to 70 years, with heart failure with reduced ejection fraction were recruited from outpatient heart failure clinics. Descriptive qualitative analysis was performed on open-ended text data. RESULTS Participants who had prior medication-related cost discussions described their experience as generally positive, but about half of the participants had never had a cost discussion with their clinician. Most participants were open to cost discussions with clinicians and preferred that the clinician initiate discussions regarding medication cost. Importantly, these preferences held constant across reported levels of financial burden. CONCLUSIONS These data suggest a substantial willingness on the part of patients with heart failure with reduced ejection fraction to incorporate cost discussions into their care and identify important aspects of these discussions for clinicians to consider when engaging in conversations where cost is relevant. Improving understanding about how to integrate patient preferences regarding cost discussions into clinical encounters is an important priority for advancing patient-centered care.
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Affiliation(s)
- Birju R Rao
- Division of Cardiology, Department of Medicine (B.R.R., N.W.D., A.A.M., C.D.S., G.H.S.), Emory University School of Medicine, Atlanta, GA
| | - Neal W Dickert
- Division of Cardiology, Department of Medicine (B.R.R., N.W.D., A.A.M., C.D.S., G.H.S.), Emory University School of Medicine, Atlanta, GA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (N.W.D.)
| | - Alanna A Morris
- Division of Cardiology, Department of Medicine (B.R.R., N.W.D., A.A.M., C.D.S., G.H.S.), Emory University School of Medicine, Atlanta, GA
| | - Candace D Speight
- Division of Cardiology, Department of Medicine (B.R.R., N.W.D., A.A.M., C.D.S., G.H.S.), Emory University School of Medicine, Atlanta, GA
| | - Graham H Smith
- Division of Cardiology, Department of Medicine (B.R.R., N.W.D., A.A.M., C.D.S., G.H.S.), Emory University School of Medicine, Atlanta, GA
| | - Supriya Shore
- Department of Medicine, Division of Cardiology, University of Michigan Medical School, Ann Arbor (S.S.)
| | - Miranda A Moore
- Department of Family and Preventive Medicine (M.A.M.), Emory University School of Medicine, Atlanta, GA
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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.
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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
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Wiltshire JC, Enard KR, Colato EG, Orban BL. Problems paying medical bills and mental health symptoms post-Affordable Care Act. AIMS Public Health 2020; 7:274-286. [PMID: 32617355 PMCID: PMC7327393 DOI: 10.3934/publichealth.2020023] [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: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 11/29/2022] Open
Abstract
Healthcare affordability is a worry for many Americans. We examine whether the relationship between having problems paying medical bills and mental health problems changed as the Affordable Care Act (ACA) was implemented, which increased health insurance coverage. Data from the 2013–2016 Health Reform Monitoring Survey, a survey of Americans aged 18–64, were used. Using zero-inflated negative binomial regression, adjusted for predisposing, enabling, and need factors, we examined differences in days of mental health symptoms by problems paying medical bills (n = 85,430). From 2013 to 2016, the rates of uninsured and problems paying medical bills decreased from 15.1% to 9.0% and 22.0% to 18.6%, respectively. Having one or more days of mental health symptoms increased from 39.3% to 42.9%. Individuals who reported problems paying medical bills had more days of mental health symptoms (Beta = 0.133, p < 0.001) than those who did not have this problem. Insurance was not significantly associated with days of mental health symptoms. Over the 4-year period, there were not significant differences in days of mental health symptoms by problems paying medical bills or insurance status. Despite improvements in coverage, the relationship between problems paying medical bills and mental health symptoms was not modified.
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Affiliation(s)
| | - Kimberly R Enard
- Department of Health Management and Policy, College for Public Health & Social Justice, Saint Louis University, USA
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10
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Dine CJ, Masi D, Smith CD. Tools to Help Overcome Barriers to Cost-of-Care Conversations. Ann Intern Med 2019; 170:S36-S38. [PMID: 31060063 DOI: 10.7326/m19-0778] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Jessica Dine
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (C.J.D.)
| | | | - Cynthia D Smith
- American College of Physicians, Philadelphia, Pennsylvania (C.D.S.)
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11
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Affiliation(s)
- Caroline E Sloan
- Duke University School of Medicine, Durham, North Carolina (C.E.S.)
| | - Peter A Ubel
- Fuqua School of Business, Duke University, Durham, North Carolina (P.A.U.)
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