Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?
ABSTRACT This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.
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ABSTRACT: Purpose: Physicians prescribing new medications often do not convey important medication-related information. This study tests an intervention to improve physician-patient communication about newly prescribed medications. Methods: We conducted a controlled clinical trial of patients in 3 primary care practices, combining data from patient surveys with audio-recorded physician-patient interactions. The intervention consisted of a 1-hour physician-targeted interactive educational session encouraging communication about 5 basic elements regarding a new prescription and a patient information handout listing the 5 basic elements. Main outcome measures were the Medication Communication Index (MCI), a 5-point index assessed by qualitative analysis of audio-recorded interactions (giving points for discussion of medication name, purpose, directions for use, duration of use, and side effects), and patient ratings of physician communication about new prescriptions. Results: Twenty-seven physicians prescribed 113 new medications to 82 of 256 patients. The mean MCI for medications prescribed by physicians in the intervention group was 3.95 (SD = 1.02), significantly higher than that for medications prescribed by control group physicians (2.86, SD = 1.23, P <.001). This effect held regardless of medication type (chronic vs nonchronic medication). Counseling about 3 of the 5 MCI components was significantly higher for medications prescribed by physicians in the intervention group, as were patients' ratings of new medication information transfer (P = .02). Independent of intervention or control groups, higher MCI scores were associated with better patient ratings about information about new prescriptions (P = .003). Conclusions: A physician-targeted educational session improved the content of and enhanced patient ratings of physician communication about new medication prescriptions. Further work is required to assess whether improved communication stimulated by the intervention translates into better clinical outcomes.The Annals of Family Medicine 01/2013; 11(1):37-42. DOI:10.1370/afm.1444 · 5.43 Impact Factor
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ABSTRACT: Objectives This study aims to understand how do socio-demographic and personal factors impact the trade-offs people make in daily life in the USA due to problems in paying medical bills. Methods This study used the 2007 wave of the Health Tracking Household Survey (HTHS) data. The unit of analysis was an individual. The dependent variable was the level of trade-off. A cumulative logit model measured the effect of independent variables on the dependent variable, which was ordinal. Key findingsPre-tax family income, out-of-pocket spending for medical care during past 12 months, perceived health status, type of family, ethnicity and age had significant impact on level of trade-off experienced by individuals. Odds of making severe trade-offs increased significantly for people with low income, poor self-reported general health status, higher out-of pocket medical expenditure and single parents. Compared to white people, African-Americans were worse affected because of problems in paying medical bills. Younger people made a higher level of trade-off compared to older people because of medical debt. Conclusions Problems in paying medical bills forced people to forgo basic necessities of life, which could impact the nutritional status, access to health care and living condition of people. A higher level of trade-offs in daily life could potentially affect the health of an individual in the long run. Poor people were worst affected because of medical debt. This study could prompt policy makers to provide more support to indigent people, people with higher out-of-pocket medical expenses and those with poor health conditions to ensure adequate access to basic necessities of life.Journal of Pharmaceutical Health Services Research 06/2013; 4(2). DOI:10.1111/jphs.12015