Levels Of Financial Burden Research Articles

How does financial burden influence the crash rate among taxi drivers? A self-reported questionnaire study in China

Objective: Taxis play an important role in the transportation system of China, but they have a relatively high accident rate. The current study discusses the driver’s financial burden in the Chinese context and explores its correlation with working conditions, risky driving behavior, and other characteristics of taxi drivers who are involved in accidents.Method: A total of 2,391 taxi drivers from 29 companies in four Chinese cities were interviewed and then asked to complete a questionnaire concerning their socio-demographic characteristics, working conditions, risky driving behavior, and accident frequency during the previous two years. Given the increase in the management fee (measured in CNY) charged by taxi companies, the drivers were divided into three groups: the “less than 150” group, the” 150 to 180” group and the “over 180” group, where were named Group 1, Group 2 and Group 3, respectively. Finally, the zero-inflated Poisson model was used to investigate the factors that contributed to the accident rate for each group.Result: The significant factors that lead to accidents differed significantly for drivers with different levels of financial burden. First, most of the factors were weakly correlated with the crash rate among Group 1 drivers. Second, many factors related to working conditions and risky driving behavior were significant for drivers in Groups 2 and 3, while working hours and off-duty days were significant only for drivers in Group 3. Third, working hours were negatively correlated with accident rates for drivers in Group 3, and the drivers who suffered from the heaviest financial burden were most affected by fatigue and sleep problems.Conclusion: Financial burden is the root cause behind the propensity of taxi drivers to be involved in accidents. Taxi companies should find ways to reduce drivers’ expenses, and new technologies, such as taxi-calling or location and navigation based on mobile applications, should be introduced into the traditional taxi industry.

Abstract 21: Heart Failure and Shared Decision-making: Patients’ Perspectives Regarding Medication-related Cost Discussions

Background: Patients with heart failure with reduced ejection fraction (HFrEF) take on average 6 medications daily and can face considerable out-of-pocket medication costs. This issue has become particularly salient as newer medications such as sacubitril-valsartan have emerged as beneficial. As clinicians attempt to maximize benefits for this population, discussions of medication costs between patients and clinicians are critical. However, cost discussions are known to be infrequent and often suboptimal. Objective: To explore patients’ perspectives on discussing out-of-pocket medication costs with clinicians. Methods: 49 adults, aged 44-70, with HFrEF meeting general eligibility criteria for sacubitril-valsartan were recruited from outpatient heart failure clinics and inpatient services. Descriptive quantitative analysis of closed-ended and multiple-choice responses was conducted. Qualitative descriptive analysis of open-ended text data was performed. Results: About half (49%) of participants reported any previous discussion with clinicians about out-of-pocket cost related to medication. These participants described their experience with cost discussions at the time of prescription as generally positive. Specific ways these discussions were helpful included clarifying cost-benefit tradeoffs and identifying opportunities for cost reduction. Most participants (96%) were open to cost discussions with their clinician, and many (69%) specifically preferred that clinicians initiate discussions regarding medication cost. There were no differences in cost discussion preferences between participants who employed different decision-making approaches about initiation of sacubitril-valsartan or across levels of financial burden. Conclusion: Out-of-pocket cost is a relevant component of patient-centered medical decisions, particularly for patients with HFrEF. These data suggest patients with HFrEF are receptive to incorporating cost discussions into care and identify some of the ways these discussions may be helpful. Further research is needed to clarify how best to identify patient-specific cost at the time of clinical encounters and how to work with patients to make cost-benefit assessments.

The heterogeneity in financial and time burden of caregiving to children with chronic conditions.

We examine the financial and time burdens associated with caring for children with chronic conditions, focusing on disparities across types of conditions. Using linked data from the 2003 to 2006 National Health Interview Survey and 2004-2008 Medical Expenditure Panel Survey, we created measures of financial burden (out-of-pocket healthcare costs, the ratio of out-of-pocket healthcare costs to family income, healthcare costs paid by insurance, and total healthcare costs) and time burden (missed school time due to illness or injury and the number of doctor visits) associated with 14 groups of children's chronic conditions. We used the two-part model to assess the effect of condition on financial burden and finite mixture/latent class model to analyze the time burden of caregiving. Controlling for the influences of other socio-demographic characteristics on caregiving burden, children with chronic conditions have higher financial and time burdens relative to caregiving burdens for healthy children. Levels of financial burden and burden sharing between families and insurance system also vary by type of condition. For example, children with pervasive developmental disorder or heart disease have a relatively low financial burden for families, while imposing a high cost on the insurance system. In contrast, vision difficulties are associated with a high financial burden for families relative to the costs borne by others. With respect to time burden, conditions such as cerebral palsy and heart disease impose a low time burden, while conditions such as pervasive developmental disorder are associated with a high time burden. This study demonstrates that differences exist in caregiving burden for children by type of chronic condition. Each condition has a unique profile of time and financial cost burden for families and the insurance system. These results have implications for policymakers and for families' savings and employment decisions.