Islam M Mofizul, Yen Laurann, Valderas Jose M, McRae Ian S
Australian Primary Health Care Research Institute, Australian National University, Building 63, Cnr, Mills & Eggleston Roads, Acton ACT 2601, Canberra, Australian Capital Territory, Australia.
BMC Public Health. 2014 Sep 27;14:1008. doi: 10.1186/1471-2458-14-1008.
Out of pocket expenditure (OOPE) on healthcare is related to the burden of illness and the number of chronic conditions a patient experiences, but the relationship of these costs to particular conditions and groups of conditions is less studied. This study examines the effect on OOPE of various morbidity groupings, and explores the factors associated with a 'heavy financial burden of OOPE' defined by an expenditure of over 10% of equivalised household income on healthcare.
Data were collected from 4,574 senior Australians using a stratified sampling procedure by age, rurality and state of residence. Natural clusters of chronic conditions were identified using cluster analysis and clinically relevant clusters based on expert opinion. We undertook logistic regression to model the probability of incurring OOPE, and a heavy financial burden; linear regression to explore the significant factors of OOPE; and two-part models to estimate the marginal effect of factors on OOPE.
The mean OOPE in the previous three months was AU$353; and 14% of respondents experienced a heavy financial burden. Medication and medical service expenses were the major costs. Those who experienced cancer, high blood pressure, diabetes or depression were likely to report higher OOPE. Patients with cancer or diabetes were more likely than others to face a heavy burden of OOPE relative to income. Total number of conditions and some specific conditions predict OOPE but neither the clusters nor pairs of conditions were good predictors of OOPE.
Total number of conditions and some specific conditions predict both OOPE and heavy financial burden but particular comorbid groupings are not useful in predicting OOPE. Low-income patients pay a higher proportion of income than the well-off as OOPE for healthcare. Interventions targeting those who are likely to face severe financial burdens due to their health could address some of these differences.
医疗保健的自付费用（OOPE）与疾病负担以及患者所患慢性病的数量有关，但这些费用与特定疾病及疾病组之间的关系鲜少被研究。本研究考察了各种发病分组对自付费用的影响，并探究了与“自付费用的沉重经济负担”相关的因素，该负担定义为医疗保健支出超过等值家庭收入的10%。
采用分层抽样程序，根据年龄、农村地区和居住州，从4574名澳大利亚老年人中收集数据。使用聚类分析确定慢性病的自然聚类，并根据专家意见确定临床相关聚类。我们进行逻辑回归以模拟产生自付费用和沉重经济负担的概率；进行线性回归以探究自付费用的显著因素；并采用两部分模型来估计各因素对自付费用的边际效应。
前三个月的平均自付费用为353澳元；14%的受访者承受着沉重的经济负担。药物和医疗服务费用是主要支出。患有癌症、高血压、糖尿病或抑郁症的人报告的自付费用可能更高。相对于收入而言，癌症或糖尿病患者比其他人更有可能面临沉重的自付费用负担。疾病总数和一些特定疾病可预测自付费用，但聚类或疾病对都不是自付费用的良好预测指标。
疾病总数和一些特定疾病既可以预测自付费用，也可以预测沉重的经济负担，但特定的合并症分组对预测自付费用并无帮助。低收入患者作为医疗保健自付费用支付的收入比例高于富裕患者。针对那些可能因其健康状况而面临严重经济负担的人的干预措施可以解决其中一些差异。
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