Impact of Out-of-Pocket Spending Caps on Financial Burden of those with Group Health Insurance

Riggs, Kevin R.; Buttorff, Christine; Alexander, G. Caleb

doi:10.1007/s11606-014-3127-z

Cited by 8 publications

(7 citation statements)

References 12 publications

(8 reference statements)

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“…Future investigations perhaps should track the path from distal causes of population health (eg, political and economic factors) (18) to measures of diabetes maintenance. For example, in the complex and shifting world of health insurance, mechanisms such as "churning" in and out of coverage or increasing underinsurance though various out-of-pocket expenses (19)(20)(21)(22)(23) may explain patterns of incomplete care more than the simple type of payer does.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Quality of Care and Maintenance in New England: Can Cross-State Collaboration Move Us Forward?

et al. 2018

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Introduction State efforts to identify subpopulations at higher risk for inadequate diabetes maintenance are sometimes hampered by small sample size. We provide a model of a cross-state collaboration that might provide the foundation for identifying political and economic forces underlying inter-and intra-state variability in chronic disease care. Conclusion Inadequate annual diabetes care among adults with diagnosed diabetes was endemic even in this relatively advantaged US census division, and traditional disparities (eg, race/ethnicity, FPL bracket) only partially explained patterns in diabetes maintenance activities. Interstate analyses can create the foundation for active partnerships to identify and address the causes of lapses in care.

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Section: Discussionmentioning

confidence: 99%

Diabetes Quality of Care and Maintenance in New England: Can Cross-State Collaboration Move Us Forward?

et al. 2018

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“…This accords with recent publications using unaffordability as a measure of financial barriers. 16 , 17 , 18 Exact MEPS questions used to compute the unaffordability metric are found in Online Appendix A .…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…Moreover, financial burden as a measure of underinsurance is problematic because the OOP caps under ACA make it mathematically impossible for some middleincome families to reach the 10% or 20% of income threshold, despite the possibility they may be significantly impacted by their medical expenses. 16 Previous work modeling avoided or delayed care only in families with children demonstrated that in such families, a measure of these concerns is a better predictor of unmet needs than raw OOP costs. 17 It is important to note that the concept of underinsurance includes components beyond the economic concerns of avoiding care due to cost and percentage of income spent on health care expenses mentioned above.…”

Section: Introductionmentioning

confidence: 99%

Comparing Health Care Financial Burden With an Alternative Measure of Unaffordability

Kielb

Rhyan

Lee

2017

INQUIRY

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Health insurance plans with high deductibles increase exposure to health care costs, raising concerns about how the growth in these plans may be impacting both the financial burden of health care expenditures on families and their access to health care. We find that foregoing medical care is common among low-income, privately insured families, occurring at a greater rate than those with higher incomes or Medicare coverage. To better understand the relationship between out-of-pocket (OOP) spending and access, we used the 2011-2014 Medical Expenditure Panel Survey (MEPS) data and a logistic model to analyze the likelihood of avoiding or delaying needed medical care based on health insurance design and other individual and family characteristics. We find that avoiding or delaying medical care is strongly correlated with coverage under a high-deductible health plan, and with depression, poor perceived health, or poverty. However, it is relatively independent of the percent of income spent on OOP costs, making the percent of income spent on OOP costs by itself a poor measure of health care unaffordability. Individuals who spend a small percentage of their income on health care costs may still be extremely burdened by their health plan when financial concerns prevent access to health care. This work emphasizes the importance of insurance design as a predictor of access and the need to expand the definition of financial barriers to care beyond expenditures, particularly for the low-income, privately insured population.

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“…The US created a home care model, based on HST and refundable by the insurance agencies, that deals with both diagnosis and therapeutic care of OSAS patients. This services company, called the Affordable Care Act (ACA) aims to provide high quality healthcare to OSAS patients 49 50 . The ACA is gearing up towards a diagnostic model that focuses on the doctor-patient relationship.…”

Section: Health-care Providers and Models Of Care To Manage Osasmentioning

confidence: 99%

Cost-effectiveness strategies in OSAS management: a short review

Toraldo

Passàli

Sanna

et al. 2017

Acta Otorhinolaryngol Ital

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Lapnea ostruttiva del sonno (OSAS) è una malattia cronica eccessivamente sotto-diagnosticata con unalta prevalenza negli adulti. LOSAS sta diventando un problema sociale significativo perché associata ad un peggioramento della qualità della vita ed un aumento della mortalità. Il rapporto costo-efficacia nella gestione diagnostica e terapeutica dellOSAS è un problema strategico per contrastare la crescente domanda di test oggettivi. I pazienti OSAS che non presentano comorbilità clinicamente evidenti devono essere studiati utilizzando un sistema semplificato e poco costoso, come lHome Sleep Testing (HST). Al contrario, la Sleep Laboratory Polisomnography (PSG) rimane il gold standard per la gestione dei pazienti con OSAS in presenza di comorbidità. Occorre sottolineare che luso di HST potrebbe portare ad una diagnosi errata in soggetti OSAS non ben selezionati. Questa breve rassegna si propone di offrire argomenti di riflessione sulla corretta diagnosi e trattamento dellOSAS, in rapporto ai dati di prevalenza e alle ricadute sui costi/benefici sociali della malattia. Attualmente non può essere solo il rapporto costo/efficacia a definire il modello organizzativo adottato per la gestione dellOSAS, in quanto si rendono necessari ulteriori studi prospettici a lungo termine, volti a validare in maniera definitiva tale rapporto nonché il confronto tra il trattamento con modelli di gestione ospedaliera versus lassistenza domiciliare.

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Impact of Out-of-Pocket Spending Caps on Financial Burden of those with Group Health Insurance

Cited by 8 publications

References 12 publications

Diabetes Quality of Care and Maintenance in New England: Can Cross-State Collaboration Move Us Forward?

Diabetes Quality of Care and Maintenance in New England: Can Cross-State Collaboration Move Us Forward?

Comparing Health Care Financial Burden With an Alternative Measure of Unaffordability

Cost-effectiveness strategies in OSAS management: a short review

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