Who Can't Pay for Health Care?

De: Social Determinants of Health [mailto:SDOH@YORKU.CA] Em nome de Arlene Bierman
Enviada em: quarta-feira, 22 de junho de 2005 18:27
Para: SDOH@YORKU.CA
Assunto: Lessons from the US

Attached is an abstract from this months Journal of General Internal
Medicine that serves as a reminder of the inadequacy of private health
insurance fore the poor and chronically ill.

http://www.blackwell-synergy.com/doi/full/10.1111/j.1525-1497.2005.0087.x

ORIGINAL ARTICLE
Who Can't Pay for Health Care?
Robin M. Weinick, PhD1,2, Sepheen C. Byron, MHS1 and Arlene S. Bierman,
MD, MS3

Background: In an era of rising health care costs, many Americans
experience difficulty paying for needed health care services. With costs
expected to continue rising, changes to private insurance plans and
public programs aimed at containing costs may have a negative impact on
Americans' ability to afford care.

Objectives: To provide estimates of the number of adults who avoid
health care due to cost, and to assess the association of income,
functional status, and type of insurance with the extent to which people
with health insurance report financial barriers.

Research Design: Cross-sectional observational study using data from the
Commonwealth Fund 2001 Health Care Quality Survey, a nationally
representative telephone survey.

Participants: U.S. adults age 18 and older (N=6,722).

Measures: Six measures of avoiding health care due to cost, including
delaying or not seeking care; not filling prescription medicines; and
not following recommended treatment plan.

Results: The proportion of Americans with difficulty affording health
care varies by income and health insurance coverage. Overall, 16.9% of
Americans report at least 1 financial barrier. Among those with private
insurance, the poor (28.4%), near poor (24.3%), and those with
functional impairments (22.9%) were more likely to report avoiding care
due to cost. In multivariate models, the uninsured are more likely (OR,
2.3; 95% CI, 1.7 to 3.0) to have trouble paying for care. Independent of
insurance coverage and other demographic characteristics, the poor (OR,
3.6; 95% CI, 2.1 to 4.6), near poor (OR, 2.1; 95% CI, 1.9 to 3.7), and
middle-income (OR, 1.8; 95% CI, 1.3 to 2.5) respondents as well as those
with functional impairments (OR, 1.6; 95% CI, 1.3 to 2.0) are
significantly more likely to avoid care due to cost.

Conclusions: Privately and publicly insured individuals who have low
incomes or functional impairments encounter significant financial
barriers to care despite having health insurance. Proposals to expand
health insurance will need to address these barriers in order to be
effective.

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