Baughman Kristin R, Burke Ryan C, Hewit Michael S, Sudano Joseph J, Meeker James, Hull Sharon K
1 Department of Family and Community Medicine, Northeast Ohio Medical University , Rootstown, Ohio.
2 College of Public Health, Kent State University , Kent, Ohio.
Popul Health Manag. 2015 Oct;18(5):358-66. doi: 10.1089/pop.2014.0128. Epub 2015 Apr 9.
Problems paying medical bills have been reported to be associated with increased stress, bankruptcy, and forgone medical care. Using the Behavioral Model for Vulnerable Populations developed by Gelberg et al as a framework, as well as data from the 2010 Ohio Family Health Survey, this study examined the relationships between difficulty paying medical bills and forgone medical and prescription drug care. Logistic regression was used to examine associations between difficulty paying medical bills and predisposing, enabling, need (health status), and health behaviors (forgoing medical care). Difficulty paying medical bills increased the effect of lack of health insurance in predicting forgone medical care and had a conditional effect on the association between education and forgone prescription drug care. Those who had less than a bachelor's degree were more likely to forgo prescription drug care than those with a bachelor's degree, but only if they had difficulty paying medical bills. Difficulty paying medical bills also accounted for the relationships between several population characteristics (eg, age, income, home ownership, health status) in predicting forgone medical and prescription drug care. Policies to cap out-of-pocket medical expenses may mitigate health disparities by addressing the impact of difficulty paying medical bills on forgone care.
据报道，支付医疗费用存在困难与压力增加、破产以及放弃医疗服务有关。本研究以Gelberg等人开发的弱势群体行为模型为框架，并利用2010年俄亥俄州家庭健康调查的数据，考察了支付医疗费用困难与放弃医疗和处方药治疗之间的关系。采用逻辑回归分析来检验支付医疗费用困难与易感性、促成因素、需求（健康状况）以及健康行为（放弃医疗服务）之间的关联。支付医疗费用困难增强了缺乏医疗保险在预测放弃医疗服务方面的影响，并且对教育与放弃处方药治疗之间的关联具有条件效应。拥有学士学位以下学历的人比拥有学士学位的人更有可能放弃处方药治疗，但前提是他们在支付医疗费用方面存在困难。支付医疗费用困难在预测放弃医疗和处方药治疗方面还解释了几个人口特征（如年龄、收入、房屋所有权、健康状况）之间的关系。限制自付医疗费用的政策可能通过解决支付医疗费用困难对放弃治疗的影响来缓解健康差距。
