Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California-Irvine, CA, USA.
J Gen Intern Med. 2012 Apr;27(4):432-7. doi: 10.1007/s11606-011-1910-7. Epub 2011 Oct 18.
The Affordable Care Act is designed to decrease the numbers of uninsured patients in U.S. However, even with insurance, patients who have financial hardships may have difficulty obtaining their medications because of cost issues.
Among patients with type 2 diabetes, to examine the association between patients' self-reported financial pressures on cost-related medication non-adherence and glucose control. Additionally, to examine whether having insurance decrease the financial pressures of diabetes care.
Racially/ethnically diverse patients (N = 1,361; 249 non-Hispanic whites, 194 Vietnamese, and 533 Mexican American) with type 2 diabetes were recruited from seven outpatient clinics for a cross-sectional, observational study.
Although both Vietnamese and Mexican-American patients reported having low annual incomes, more Mexican Americans reported the presence of financial barriers to getting medical care and perceived financial burden due to their diabetes, compared to whites and Vietnamese (p < 0.001). Over half (53.2%) of Mexican Americans reported cost-related non-adherence compared to 27.2% of white and 27.6% of Vietnamese patients (p < 0.001). Perceived financial burden was found to be associated with poor glucose control (HbA1c ≥8%), after adjusting for sociodemographic and health characteristics (aOR = 1.70, 95%CI 1.09-2.63), but not when adjusting for non-adherence. Similarly, a significant association between presence of financial barriers and HbA1c (aOR = 1.69, 95%CI 1.23-2.32) was attenuated with the inclusion of insurance status in the model. Being uninsured (aOR = 1.90, 95%CI 1.13-3.21) and non-adherent (aOR = 1.49, 95%CI 1.06-2.08) were each independently associated with HbA1c.
While having health insurance coverage eliminated some of the financial barriers associated with having diabetes, low-income patients still faced significant financial burdens. Thus, providing health insurance to more individuals is only the first step towards eliminating health disparities. It is important to address medication cost in order to improve medication adherence and glucose control.
《平价医疗法案》旨在减少美国无保险患者的数量。然而，即使有了保险，经济困难的患者也可能因为费用问题而难以获得药物。
在 2 型糖尿病患者中，研究患者报告的与药物费用相关的药物不依从与血糖控制之间的关系，以及患者的财务压力。此外，还研究了保险是否会降低糖尿病治疗的经济压力。
这项横断面观察研究共招募了来自 7 家门诊诊所的 1361 名种族/民族多样化的 2 型糖尿病患者（249 名非西班牙裔白人、194 名越南裔和 533 名墨西哥裔美国人）。
尽管越南裔和墨西哥裔美国人的年收入都较低，但与白人、越南裔相比，更多的墨西哥裔美国人报告存在获得医疗保健的经济障碍，并因糖尿病而感到经济负担过重（p<0.001）。超过一半（53.2%）的墨西哥裔美国人报告存在与费用相关的不依从，而白人患者和越南裔患者分别为 27.2%和 27.6%（p<0.001）。调整社会人口学和健康特征后，发现感知到的经济负担与血糖控制不佳（HbA1c≥8%）相关（aOR=1.70，95%CI 1.09-2.63），但与不依从无关。同样，在模型中纳入保险状况后，经济障碍的存在与 HbA1c 之间的显著相关性（aOR=1.69，95%CI 1.23-2.32）减弱。没有保险（aOR=1.90，95%CI 1.13-3.21）和不依从（aOR=1.49，95%CI 1.06-2.08）与 HbA1c 均独立相关。
尽管有医疗保险覆盖消除了与糖尿病相关的一些经济障碍，但低收入患者仍面临着巨大的经济负担。因此，为更多人提供医疗保险只是消除健康差异的第一步。为了改善药物依从性和血糖控制，解决药物费用问题很重要。
