Out‐of‐Pocket Financial Burden for Low‐Income Families with Children: Socioeconomic Disparities and Effects of Insurance

Galbraith, Alison A.; Wong, Sabrina T.; Kim, Sue E.; Newacheck, Paul W.

doi:10.1111/j.1475-6773.2005.00421.x

Cited by 86 publications

(67 citation statements)

References 23 publications

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“…Recent literature points to the increasing burden of out-of-pocket expenditures, even among insured populations. [15][16][17][18][19] Two previous studies of the role of financial constraints in TKA disparities among Medicare FFS beneficiaries leave a confusing picture. Mahomed et al 4 concluded that those "whose income level was low enough to qualify for Medicaid supplementation were much less likely to undergo total knee replacement than individuals who did not receive Medicaid supplementation," whereas Skinner et al 6 saw "little association between socioeconomic status and the rate of TKA."…”

mentioning

confidence: 99%

Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty

Hanchate¹,

Zhang²,

Felson³

et al. 2008

Medical Care

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Objective-To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use. Data Source-US longitudinal Health and Retirement Study survey data for the elderly and nearelderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan.Study Design-The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators.Sample-Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA.Results-Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95% CI: 1.03-2.26) to have first TKA.Conclusions-Limited insurance coverage and financial constraints explain some of the racial/ ethnic disparities in TKA rates.Total knee arthroplasty (TKA) is increasingly common with over 431,000 procedures performed nationwide in 2004. 1 For persons with severe and potentially disabling osteoarthritis, TKA is "efficacious and cost-effective …[it] relieves pain and reduces functional disability." 2 As the US population ages, growth in TKAs is expected to accelerate. A study of Canadians aged 55 or older concluded that those with less education and lower income were more likely to need TKA and similarly willing to undergo TKA as those with more education or income. 20 To the extent that these findings apply to the United States, lower TKA utilization among minorities with lower SES is not necessarily due to unwillingness to undergo TKA.A related study of disparities in joint (knee and hip) replacement based on a nationally representative (US) longitudinal survey sample of 6159 Medicare-enrolled adults (age 69 or older) found that those with supplementary Medigap coverage were more likely to have a joint replacement compared with those without. 21 The apparent difference with Skinner et al 6 may be due to the more detailed individual-level financial and insurance coverage measures in Dunlop et al. 21 Although the data used in this study are from the same survey source [Health and Retirement Study (HRS)] as ...

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confidence: 99%

Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty

Hanchate¹,

Zhang²,

Felson³

et al. 2008

Medical Care

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“…31,32 Prior research has used Andersen's model to examine factors that affect out-of-pocket expenditures in multivariate analysis. 33 For the purposes of current research, we focused only on specific enabling (presence and type of insurance and income) and healthcare environment factors (facility type and geographic region) while controlling for predisposing, need, and health behaviors. Healthcare environment associations with out-of-pocket mammography expenditures were determined by the region of the United States in which a woman resided and the type of facility in which the mammogram was received.…”

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confidence: 99%

A National Study of Out-of-Pocket Expenditures for Mammography Screening

LeMasters

Sambamoorthi

2011

Journal of Women's Health

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Ordinary least squares regression was used to describe relationships among out-of-pocket mammography expenditures, total mammography expenditures, and out-of-pocket mammography expenditures as a percentage of total mammography expenditures and such independent variables as insurance status and type, income, region of the United States, and type of facility where a mammogram was received. Results: The average out-of-pocket expenditure for a mammogram in 2007 or 2008 was $33, representing 14.1% of the total mammogram expenditure ($266). After controlling for demographic and health factors, women who were uninsured, were from the Midwest, and had a mammogram at an office-based facility had greater out-ofpocket mammography expenditures. Women who were uninsured, lived in the South, and received their mammogram at an office-based facility had out-of-pocket mammography expenditures that represented a greater proportion of the total mammography expenditures. Conclusions: Large variations in out-of-pocket expenditures were observed among women with and without insurance and between insurance types, geographic regions of the United States, and types of facilities where mammograms were received. A higher financial burden of mammography screening among some subgroups of women may act as a barrier to future mammography screening.

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“…Low-income families with children pay proportionately more for health care than higher-income families (Lee, 2009). In a 2005 study, U.S. low-income families spent a mean of $120 on child health care for every $1000 earned, whereas middle class families spent a mean of $56 on child health care for every $1000 earned, and wealthy families spent a mean of only $38 on child health care for every $1000 earned (Galbraith, Wong, Kim, & Newacheck, 2005). In a 2011 study, families in lowest income bracket spent more than 20% of their earnings on health care (Ketsche, Adams, Wallace, Kannan, & Kannan, 2011).…”

Section: Health Spending Compared For Us Family Income Levelsmentioning

confidence: 99%

A Plain View of Poor Health in a Land of Plenty

Stipp

2015

Social Work in Public Health

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This article provides a clear description of U.S. health spending that is on a steep upward trajectory, and U.S. health outcomes on a downward trajectory, as compared to other nations. The article is written to inform social workers and other health professionals, who observe the poor health of their clients in a high-resource nation, while the nation banters about health care reform. This report presents international and national health resource and outcome comparisons, with implications for sustainable support for U.S population health and national capabilities.

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Out‐of‐Pocket Financial Burden for Low‐Income Families with Children: Socioeconomic Disparities and Effects of Insurance

Abstract: Socioeconomic disparities exist in the financial burden of OOP health care expenditures for families with children. For low-income families, full-year public coverage provides significantly greater protection from financial burden than full-year private coverage.

Cited by 86 publications

References 23 publications

Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty

Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty

A National Study of Out-of-Pocket Expenditures for Mammography Screening

A Plain View of Poor Health in a Land of Plenty

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