Center for Studying Health System Change, Washington, DC 20024, USA.
Med Care Res Rev. 2011 Jun;68(3):352-66. doi: 10.1177/1077558710378122. Epub 2010 Sep 9.
This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.
本研究考察了医疗保健的可负担性门槛是否随时间变化而变化。两项全国代表性调查的结果表明，虽然 2003 年至 2007 年间，因医疗费用而产生的经济压力（定义为存在支付医疗费用问题的比例）有所增加，但对于拥有雇主提供保险的高收入人群而言，只有更多的自付费用才能解释这种增加。较低收入人群的自付费用增加并没有导致医疗账单问题的增加。此外，低收入人群的医疗账单问题增加发生在相对较低的自付费用水平，而不是更高的水平。研究结果表明，个人和家庭所定义的“医疗保健可负担性门槛”并非一成不变，尤其是对于低收入人群而言，这对制定医疗改革中的可负担性标准具有重要意义。
