Galbraith Alison A, Wong Sabrina T, Kim Sue E, Newacheck Paul W
Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA 02215, USA.
Health Serv Res. 2005 Dec;40(6 Pt 1):1722-36. doi: 10.1111/j.1475-6773.2005.00421.x.
To determine whether socioeconomic disparities exist in the financial burden of out-of-pocket (OOP) health care expenditures for families with children, and whether health insurance coverage decreases financial burden for low-income families.
The Household Component of the 2001 Medical Expenditure Panel Survey.
Cross-sectional family-level analysis. We used bivariate statistics to examine whether financial burden varied by poverty level. Multivariate regression models were used to assess whether family insurance coverage was associated with level of financial burden for low-income families. The main outcome was financial burden, defined as the proportion of family income spent on OOP health care expenditures, including premiums, for all family members.
DATA COLLECTION/EXTRACTION: We aggregated annual OOP expenditures for all members of 4,531 families with a child <18 years old. Family insurance coverage was categorized as follows: (1) all members publicly insured all year, (2) all members privately insured all year, (3) all members uninsured all year, (4) partial coverage, or (5) mix of public and private with no uninsured periods.
A regressive gradient was noted for financial burden across income groups, with families with incomes <100 percent of the Federal Poverty Level (FPL) spending a mean of 119.66 US dollars OOP per 1,000 US dollars of family income and families with incomes 100-199 percent FPL spending 66.30 US dollars OOP per 1,000 US dollars, compared with 37.75 US dollars for families with incomes >400 percent FPL. For low-income families (<200 percent FPL), there was a 785 percent decrease in financial burden for those with full-year public coverage compared with those with full-year private insurance (p < .001).
Socioeconomic disparities exist in the financial burden of OOP health care expenditures for families with children. For low-income families, full-year public coverage provides significantly greater protection from financial burden than full-year private coverage.
确定有子女家庭的自付医疗保健支出的经济负担是否存在社会经济差异，以及医疗保险覆盖范围是否能减轻低收入家庭的经济负担。
2001年医疗支出小组调查的家庭部分。
横断面家庭层面分析。我们使用双变量统计来检验经济负担是否因贫困水平而异。多变量回归模型用于评估家庭保险覆盖范围是否与低收入家庭的经济负担水平相关。主要结果是经济负担，定义为家庭收入用于包括保费在内的所有家庭成员自付医疗保健支出的比例。
数据收集/提取：我们汇总了4531个有18岁以下子女家庭所有成员的年度自付支出。家庭保险覆盖范围分类如下：（1）所有成员全年参加公共保险；（2）所有成员全年参加私人保险；（3）所有成员全年未参保；（4）部分覆盖；或（5）公共和私人混合且无未参保期。
各收入组的经济负担呈现递减梯度，收入低于联邦贫困线（FPL）100%的家庭每1000美元家庭收入的自付支出平均为119.66美元，收入为FPL 100%-199%的家庭每1000美元自付支出为66.30美元，而收入高于FPL 400%的家庭为37.75美元。对于低收入家庭（<FPL 200%），与全年参加私人保险的家庭相比，全年参加公共保险的家庭经济负担降低了785%（p<.001）。
有子女家庭的自付医疗保健支出经济负担存在社会经济差异。对于低收入家庭，全年公共保险比全年私人保险能显著减轻经济负担。
