Richman Ilana B, Brodie Mollyann
Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA.
BMC Health Serv Res. 2014 Sep 25;14:435. doi: 10.1186/1472-6963-14-435.
Rising health care costs and increased cost sharing have resulted in significant medical expenses for many Americans. The goal of this study was to describe the prevalence of and risk factors for burdensome health care costs among non-elderly Americans.
This was a cross sectional study of a nationally representative sample of non-elderly Americans. We used survey data previously collected by the Kaiser Family Foundation. We used logistic regression to identify key risk factors for burdensome health care costs and to assess whether risk factors differ according to age within our study population. For analyses comparing younger and middle-aged adults, we compared participants ages 18-39 (younger Americans) to those ages 40-64 (middle-aged Americans).
Our study population included 5,493 participants. Twenty seven percent of participants reported difficulty paying medical bills, a prevalence that did not differ by age. Low income, lack of health insurance, and poor health were independently associated with difficulty paying medical bills after controlling for demographic covariates. Both younger and middle-aged adults were likely to experience burdensome health care costs at low incomes. At moderate incomes, risk fell for middle-aged adults, but remained high for younger adults (ORmiddle-age 1.40, 95% CI 1.12-1.75, ORyounger 2.48, 95% CI 1.73-3.57, p value for interaction 0.004). Younger adults without insurance were at risk for accruing burdensome costs compared to their insured counterparts (OR 2.61, 95% CI 1.96-3.47). Middle-aged adults without insurance, though, had an even higher risk (OR 3.82, 95% CI 2.93-4.97, p value for interaction 0.037).
Both younger and middle-aged adults commonly report difficulty paying medical bills. Younger adults remain vulnerable to burdensome medical costs even when earning moderate incomes. Middle-aged adults, however, are more likely to encounter burdensome costs when uninsured. These findings suggest that younger and middle-aged adults experience distinct vulnerabilities and may benefit differentially from health reform efforts intended to expand coverage and limit out-of-pocket expenses.
医疗保健成本的上升以及成本分担的增加给许多美国人带来了巨额医疗费用。本研究的目的是描述美国非老年人群中高额医疗保健成本的患病率及其风险因素。
这是一项对具有全国代表性的美国非老年人群样本的横断面研究。我们使用了凯撒家庭基金会先前收集的调查数据。我们采用逻辑回归来确定高额医疗保健成本的关键风险因素，并评估风险因素在我们的研究人群中是否因年龄而异。对于比较年轻和中年成年人的分析，我们将18 - 39岁的参与者（年轻美国人）与40 - 64岁的参与者（中年美国人）进行了比较。
我们的研究人群包括5493名参与者。27%的参与者报告支付医疗账单有困难，这一患病率在各年龄组中无差异。在控制人口统计学协变量后，低收入、缺乏医疗保险和健康状况不佳与支付医疗账单困难独立相关。低收入时，年轻和中年成年人都可能面临高额医疗保健成本。中等收入时，中年成年人的风险降低，但年轻成年人的风险仍然很高（中年成年人优势比1.40，95%置信区间1.12 - 1.75；年轻成年人优势比2.48，95%置信区间1.73 - 3.57，交互作用p值0.004）。与有保险的年轻成年人相比，无保险的年轻成年人有产生高额成本的风险（优势比2.61，95%置信区间1.96 - 3.47）。然而，无保险的中年成年人风险更高（优势比3.82，95%置信区间2.93 - 4.97，交互作用p值0.037）。
年轻和中年成年人普遍报告支付医疗账单有困难。即使收入中等，年轻成年人仍易受高额医疗成本的影响。然而，中年成年人在无保险时更有可能面临高额成本。这些发现表明，年轻和中年成年人面临不同的脆弱性，可能会从旨在扩大保险覆盖范围和限制自付费用的医疗改革努力中获得不同程度的益处。
