Division of Nephrology; Center for Advancing Population Science (CAPS), Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.
Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
Am J Med Sci. 2019 Aug;358(2):149-158. doi: 10.1016/j.amjms.2019.05.005. Epub 2019 May 23.
High out-of-pocket (OOP) cost is a barrier to healthcare access and treatment compliance. Our study examined high OOP healthcare cost and burden trends in adults with kidney disease (KD).
Using Medical Expenditure Survey 2002-2011 data, we examined the proportion of people greater than 17 years old with KD whose OOP burden was high. Trends by insurance status (private, public or none) and trends by income level (poor, low, middle or high income) were also examined in this study.
Approximately 16% of people with KD faced high OOP burden in 2011. The proportion of adults with high OOP burden between 2002 and 2011 fell by 9.7 percentage points. The proportion of privately insured adults facing high OOP burden decreased by 4.7, those who were publicly insured 22.4, and those who were uninsured, 3.1 percentage points. The proportion of those facing high OOP burden who were poor/near poor fell by 26.5, those who had low income 13.4, and those who had middle income, 9 percentage points.
Though high OOP burden declined between 2002 and 2011 in the US population with KD, most of the decline was among the publicly insured, so the uninsured populations with KD remain vulnerable. Providers and policy makers should be aware of the vulnerability of uninsured individuals with KD to high OOP burden.
自付费用过高是获得医疗保健和治疗依从性的障碍。我们的研究调查了患有肾脏疾病 (KD) 的成年人的高自付医疗费用和负担趋势。
使用 2002-2011 年的医疗支出调查数据，我们检查了 17 岁以上患有 KD 的人中有多少人的自付负担过重。本研究还检查了不同保险状况（私人、公共或无保险）和不同收入水平（贫困、低收入、中等收入或高收入）的趋势。
大约 16%的 KD 患者在 2011 年面临高自付负担。2002 年至 2011 年间，面临高自付负担的成年人比例下降了 9.7 个百分点。私人保险成年人面临高自付负担的比例下降了 4.7%，公共保险成年人上升了 22.4%，无保险成年人上升了 3.1%。面临高自付负担的贫困人口/接近贫困人口比例下降了 26.5%，低收入人群比例下降了 13.4%，中等收入人群比例下降了 9%。
尽管 2002 年至 2011 年间美国 KD 患者的高自付负担有所下降，但大部分下降发生在公共保险人群中，因此 KD 无保险人群仍然很脆弱。提供者和政策制定者应意识到 KD 无保险人群对高自付负担的脆弱性。
