Wisk Lauren E, Gangnon Ronald, Vanness David J, Galbraith Alison A, Mullahy John, Witt Whitney P
Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Population Health Sciences, School of Medicine and Public Health University of Wisconsin, Madison, Madison, WI.
Health Serv Res. 2014 Dec;49(6):1852-74. doi: 10.1111/1475-6773.12248. Epub 2014 Oct 18.
To develop and validate a theoretically based and empirically driven objective measure of financial burden for U.S. families with children.
The measure was developed using 149,021 families with children from the National Health Interview Survey, and it was validated using 18,488 families with children from the Medical Expenditure Panel Survey.
We estimated the marginal probability of unmet health care need due to cost using a bivariate tensor product spline for family income and out-of-pocket health care costs (OOPC; e.g., deductibles, copayments), while adjusting for confounders. Recursive partitioning was performed on these probabilities, as a function of income and OOPC, to establish thresholds demarcating levels of predicted risk.
We successfully generated a novel measure of financial burden with four categories that were associated with unmet need (vs. low burden: midlow OR: 1.93, 95 percent CI: 1.78-2.09; midhigh OR: 2.78, 95 percent CI: 2.49-3.10; high OR: 4.38, 95 percent CI: 3.99-4.80). The novel burden measure demonstrated significantly better model fit and less underestimation of financial burden compared to an existing measure (OOPC/income ≥ 10 percent).
The newly developed measure of financial burden establishes thresholds based on different combinations of family income and OOPC that can be applied in future studies of health care utilization and expenditures and in policy development and evaluation.
开发并验证一种基于理论且由实证驱动的针对美国家庭育有子女情况的经济负担客观测量方法。
该测量方法是利用来自国家健康访谈调查的149,021个育有子女的家庭开发的，并使用来自医疗支出小组调查的18,488个育有子女的家庭进行验证。
我们使用家庭收入和自付医疗费用（如免赔额、共付额）的双变量张量积样条估计因成本导致未满足医疗需求的边际概率，同时对混杂因素进行调整。根据这些概率，以收入和自付医疗费用为函数进行递归划分，以确定划分预测风险水平的阈值。
我们成功生成了一种新的经济负担测量方法，该方法有四个与未满足需求相关的类别（与低负担相比：中低比值比：1.93，95%置信区间：1.78 - 2.09；中高比值比：2.78，95%置信区间：2.49 - 3.10；高比值比：4.38，95%置信区间：3.99 - 4.80）。与现有测量方法（自付医疗费用/收入≥10%）相比，新的负担测量方法显示出显著更好的模型拟合度，且对经济负担的低估程度更小。
新开发的经济负担测量方法基于家庭收入和自付医疗费用的不同组合确定阈值，可应用于未来医疗保健利用和支出的研究以及政策制定与评估。
