142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

303741
Development of a Novel, Objective Measure of Healthcare-Related Financial Burden for U.S. Families

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 11:34 AM - 11:50 AM

Lauren Wisk, PhD , Department of Population Medicine, Center for Child Health Care Studies, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
The goal of this study was to develop a theoretically-based and empirically-driven objective measure of financial burden for US families with children.

The measure was developed using data on 149,021 families with children from the National Health Interview Survey, and validated using data on 18,488 families with children from the Medical Expenditure Panel Survey. We estimated the marginal probability of unmet healthcare need using bivariate, tensor product splines for family income and healthcare expenditures, while adjusting for relevant predisposing, need and enabling factors. Recursive partitioning was then performed on these marginal probabilities, as a function of income and expenditures, in order to empirically establish thresholds which demarcate different levels of predicted risk. These grouping were further collapsed to create a novel measure of financial burden (4 groups); the performance of this novel measure was evaluated and validated.

Multivariable results revealed that, compared to ‘low burden,’ increasing categories of burden demonstrated increased odds of unmet need (mid-low OR: 1.86, 95%CI: 1.71-2.01; mid-high OR: 2.70, 95%CI: 2.48-2.94; high OR: 4.46, 95%CI: 4.11-4.84). The validation sample yielded similar results. Compared to the novel measure of burden, use of an existing measure led to substantial underestimation of financial burden and demonstrated substantially worse model fit.

The newly-developed measure of financial burden could be applied in future studies of healthcare utilization and expenditures (e.g., to improve identification of financial burden among families) and has implications for use in policy development and evaluation (e.g., ACA’s current use of income thresholds for premium and cost-sharing subsidies).

Learning Areas:

Biostatistics, economics
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Identify the limitations of existing measures of financial burden. Explain why a novel measure of financial burden (which takes into account the family context) is needed for policy and research purposes. Describe the novel methodology used to create the new measure of financial burden. Discuss the performance of the novel measure and its applications for future research.

Keyword(s): Health Care Costs, Methodology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I devised the research question, developed the methodology, conducted all analyses and wrote the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.