Medical Expenditure Panel Survey Research Articles

50461 Regional Differences in Outpatient Dermatology Costs: An Analysis of the Medical Expenditure Panel Survey

50461 Regional Differences in Outpatient Dermatology Costs: An Analysis of the Medical Expenditure Panel Survey

Medical costs and incremental medical costs of asthma among workers in the United States.

Asthma, a chronic respiratory disease, is associated with high economic burden. This study estimates per-worker medical and incremental medical costs associated with treated asthma by socioeconomic and demographic characteristics, industries, medical events, and sources of payments for workers aged ≥18 years. We analyzed Medical Expenditure Panel Survey data from 2018 to 2020 to assess medical costs for treated asthma among workers using the International Classification of Diseases, Tenth Revision, Clinical Modification code for asthma (J45). We used two-part regression models to estimate medical and incremental medical costs controlling for covariates. All results are adjusted for inflation and presented in 2022 US dollar values. An estimated annual average of 8.2 million workers out of 176 million had at least one medical event associated with treated asthma. The annualized estimated per-worker incremental medical costs for those with treated asthma was $457 and was highest among: those in the age group of 35-44 years ($534), in the western region ($768), of Hispanic ethnicity ($693), employed in the utility and transportation industries ($898), males ($650), and for inpatient admissions ($754). The total annualized medical costs of treated asthma was $21 billion and total of incremental medical costs was $3.8 billion. Findings of higher incremental medical costs for treated asthma among workers in certain socioeconomic, demographic, and industry groups highlight the economic benefit of prevention and early intervention to reduce morbidity of asthma in working adults. Our results suggest that the per-person incremental medical costs of treated asthma among workers are lower than that for all US adults.

54695 Access to specialist care and perceived care quality among melanoma and non-melanoma skin cancer patients: A Medical Expenditure Panel Survey Analysis

54695 Access to specialist care and perceived care quality among melanoma and non-melanoma skin cancer patients: A Medical Expenditure Panel Survey Analysis

Economic and Humanistic Burden of Rheumatoid Arthritis: Results From the US National Survey Data 2018-2020.

Our objective was to estimate the economic and humanistic burden among US adults with rheumatoid arthritis (RA). This study analyzed results from the Medical Expenditure Panel Survey from 2018 to 2020. Adults (aged ≥18 years) self-reporting with RA or with the presence of the International Classification of Disease, 10th Revision clinical modification codes were identified. Healthcare expenditures (inpatient care, outpatient care, emergency department, office visits, prescription medications, home health, and others) were measured. The Short Form 12 Health Survey physical component summary (PCS), mental component summary (MCS), activities of daily living (ADL), and instrumental ADL (IADL) were measured. Two-part models assessed the incremental increase in the health care expenditures for the RA group compared to the non-RA group. In addition, the multivariable linear regression was used to evaluate the marginal difference in PCS and MCS between those with RA and those without RA, whereas the multivariable logistic regression models were used to evaluate the association between ADL and IADL by RA status. Annually, 4.27 million adults with RA were identified. The two-part model showed significantly higher total annual healthcare expenditures in the RA group than non-RA group (mean $3,382.971 [95% confidence interval (CI) $1,816.50-$4,949.44]). Compared to the non-RA group, the RA group was associated with lower PCS scores (mean4.78 [95% CI 3.47-6.09]) and similarly lower MCS scores (mean -0.84 [95% CI -2.18 to 0.50]), as well as increased odds of requesting ADL (adjusted odds ratio [aOR] 2.02 [95% CI 1.59-2.56]) and IADL assistance (aOR 2.11 [95% CI 1.57-2.84]). RA was associated with higher health care expenditures, particularly prescription medication costs, and was associated with suboptimal quality of life.

Medicaid expansion and opioid prescriptions: Evidence from the Medical Expenditure Panel Survey.

Evidence is mixed on whether increased access to insurance, specifically through the ACA's Medicaid expansion, exacerbated the opioid public health crisis through increased opioid prescribing. Using survey data on retail prescription drug fills from 2008 to 2019, we did not find a significant relationship between Medicaid expansion and opioid prescribing in the newly eligible Medicaid population. It may be that the dangers of opioids were known well enough by the time of the Medicaid expansion that lack of access to care was no longer a binding constraint on opioid prescription receipt.

Precarious employment and mental health in the United States: Results from the Medical Expenditure Panel Survey (MEPS), 2008–2021

ObjectivesTo measure associations between employment precarity and mental health among United States (US) workers. MethodsThis study used data from the US Medical Expenditure Panel Survey for 2008–2021. Multivariable generalized estimating equations were used to measure associations between employment precarity (operationalized as a multi-dimensional exposure) and self-rated mental health after adjusting for relevant confounders. Marginal effects analysis was used to assess potential dose-response relationships between precarity and mental health. ResultsOur sample (n = 57,529) was representative of >106 million US workers employed throughout 2008–2021. Compared to those with low levels of employment precarity, those with medium and high levels of precarity had an increased odds of reporting poor/fair mental health (aOR = 1.21; 95% CI = 1.11, 1.32 and 1.51; 95% CI = 1.36, 1.68, respectively). Marginal effects analysis indicated that increasing levels of precarity were associated with an increased probability of reporting poor/fair mental health. ConclusionsIncreasing levels of employment precarity were associated with poor/fair self-rated mental health, findings potentially indicative of a dose-response relationship between the two. These nationally representative findings suggest employment precarity is an important social determinant of mental health. Future research could investigate how best to mitigate the negative effects of precarity on workers' lives and well-being, particularly regarding mental health.

Understanding racial disparities in health care expenditures for cervical cancer.

Cervical cancer demonstrates a notable efficacy in treatment, evidenced by a 92% 5-year survival rate among cases diagnosed at a localized stage. In 2020, the estimated annual national expenditure for cervical cancer care amounted to $2.3 billion in the United States. Limited real-world data are available for racial disparities in health care expenditures for cervical cancer. To evaluate racial disparities associated with annual health care expenditures among patients diagnosed with cervical cancer in the United States. A retrospective observational cohort study of annual health care expenditures in patients with cervical cancer diagnosed during 2014-2019 was performed using the Medical Expenditure Panel Survey data. In addition to the descriptive weighted analysis, an unadjusted analysis of the annual health care expenditure was conducted. An adjusted linear regression model with log transformation of the outcome variable was used to evaluate the total annual health care expenditure as well as expenditures by category across the racial groups. Overall, 826 patients with cervical cancer were identified from the Medical Expenditure Panel Survey during 2014-2019. The majority were classified as White patients (81.2%) and in the age group of 45-64 years (44.65%). On average, the total annual health care expenditure was $11,537 (95% CI = $9,887-$13,186) among the White cohort, $10,659 (95% CI = $6,704-$14,614) among the African American cohort, and $8,726 (95% CI = $6,113-$11,340) among the Hispanic cohort. After adjusting for covariates, the average total annual health care expenditure for the Hispanic cohort was 35% of the total health care expenditure of the White cohort (P < 0.001) and 46% of the African American cohort's health care expenditure (P = 0.02). Specifically, adjusted costs of office-based and outpatient visits for the Hispanic cohort were 47% (P = 0.009) and 57% (P = 0.005) lower than for the White cohort, respectively. The total annual home health care expenditure for the African American cohort was 49% lower than White patients (P = 0.03), and the Hispanic cohort's total expenditure, excluding prescription medicines, was 57% lower than African American patients (P = 0.02). This study provides valuable information regarding the health care disparities that need to be addressed among certain minority races. Reducing the disparities in health care spending across racial groups should be included as a crucial element in tackling well-established health care inequities.

Trends in utilization patterns of newer glucose-lowering drugs in US adults with type 2 diabetes and a history of coronary heart disease or heart failure: 2005–2019

BackgroundThe newer glucose-lowering drugs (GLDs), including Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), have demonstrated superior cardio- and renal protective benefits compared to older GLDs in individuals with type 2 diabetes (T2D) at high risk for cardiovascular disease (CVD). ObjectiveThis study examined the trends of the newer GLDs use in people with T2D who had a history of coronary heart disease or heart failure in the United States. MethodWe used 2005–2019 data from the Medical Expenditure Panel Survey (MEPS). Individuals with self-reported diabetes and CVD history were identified. ResultsThere was a steady increase in the use of GLP-1RA only from 2008 (3 %) to 2019 (21 %) and SGLT2i only from 2014 (5 %) to 2019 (12 %). Individuals with dual use of both newer GLD classes increased from 0.62 % in 2015 to 6 % in 2019. The overall uptake of these two newer drugs in 2019 was less than 40 %. In other words, 60 % of individuals who can substantially benefit from these newer treatments did not use the treatments. ConclusionThe use of GLP-1RA and SGLT2i among individuals with T2D and a history of CVD was low and varied by insurance type. Policy-level interventions are needed to improve the use of these newer treatments further. SummaryWe examined how newer glucose-lowering drugs are used among individuals with type 2 diabetes and at high risk for coronary heart disease or heart failure in the US. We found that 60 % of individuals who can substantially benefit from these newer treatments did not use the treatments due to the variation of insurance type.

Effects of Texas State Agency Integration on Mental Health Service Use Among Individuals with Co-occurring Cognitive Disabilities and Mental Health Conditions.

This study uses Texas's 2017 integration of the state disability and mental health agencies as a case study, combining interviews with Texas agency and advocacy organization leaders to examine perceptions of agency integration and augmented synthetic control analyses of 2014-2020 Medical Expenditure Panel Survey to examine impacts on mental health service use among individuals with co-occurring cognitive disabilities (including intellectual and developmental disabilities) and mental health conditions. Interviewees described the intensive process of agency integration and identified primarily positive (e.g., decreased administrative burden) impacts of integration. Quantitative analyses indicated no effects of integration on receipt of mental health-related services among people with co-occurring conditions. While leaders identified some potentially beneficial impacts of state agency integration, the limited impact of integration beyond the agency suggests that interventions at multiple levels of the service system, including those targeting providers, are needed to better meet the mental health service needs for this population.

Exploring the Relationship between Food Insecurity, Chronic Health Conditions, and Serious Mental Illness in the United States: Implications for Social Work.

Food insecurity (FI) is a modifiable social determinant of health that impacts approximately 10 percent of the U.S. population. FI has been linked to poorer health outcomes and higher healthcare costs. Given the prevalence of chronic health conditions in the United States, including serious mental illness (SMI), the current study aims to better understand the relationship between FI and chronic conditions, including SMI, in a nationally representative sample. Authors analyzed data from the 2016 Medical Expenditure Panel Survey household component and food security supplement. Findings indicate the prevalence of FI among those with diabetes, lung disease, stroke, and SMI is higher than among the general population, with the prevalence for those with SMI being particularly high (43 percent of the sample). Logistic regression models indicate strong, statistically significant relationships between FI and chronic conditions, including SMI, as well as FI and two or more chronic illnesses, even when controlling for sociodemographic and health factors. There are likely bidirectional relationships between FI and chronic conditions. Findings have implications for social workers, in relation to prevention and treatment of SMI and FI through direct care, advocacy, and integrated services in health, mental health, and social services.

The Hidden Costs of Psoriasis: A Population-Based Study Evaluating How Psoriasis Severity Impacts Work Absenteeism.

Psoriasis patients experience physical and emotional burdens, which may lead to work-related productivity loss. This loss carries professional and financial repercussions. It is unknown whether the extent of psoriasis affects work absenteeism. This study aims to compare work absenteeism between employed adults with mild versus moderate-to-severe psoriasis. A national, cross-sectional study using the 2009 to 2019 Medical Expenditure Panel Survey evaluated 5,209,956 (weighted) adults aged &ge; 22 years. Work absenteeism was compared between adults with mild (4,521,687 weighted) and moderate-to-severe psoriasis (688,269 weighted). Work absenteeism, as measured by the average number of episodes per year that someone was absent from work for at least a half day, was significantly higher in patients with moderate-to-severe psoriasis than in patients with mild disease (4.4 episodes vs 2.8 episodes, P=0.002). Multivariable logistic regression models showed moderate-to-severe patients were 2.68 times more likely (95% CI:1.72-4.21; P&lt;0.001) to take a half-day or more off from work than those with mild disease after adjusting for age, sex, race, ethnicity, poverty, cognitive limitations, insurance, education, and comorbidities. Disease severity directly impacts work absenteeism in psoriasis patients. Early diagnosis and treatment with appropriate therapies are needed to reduce disease severity and limit economic loss and professional ramifications associated with psoriasis. J Drugs Dermatol. 2024;23(8):640-644.&nbsp; doi:10.36849/JDD.7550.

Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study.

Minority racial and ethnic populations have the highest prevalence of type 2 diabetes mellitus but lower use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra), novel medications that reduce morbidity and mortality. Observed disparities may be due to differences in insurance coverage, which have variable cost-sharing, prior authorization, and formulary restrictions that influence medication access. To assess whether racial/ethnic differences in SGLT2i and GLP1ra use differ by payer. Cross-sectional analysis of 2018 and 2019 Medical Expenditure Panel Survey data. Adults ≥ 18years old with diabetes. We defined insurance as private, Medicare, or Medicaid using ≥ 7months of coverage in the calendar year. We defined race/ethnicity as White (non-Hispanic) vs non-White (including Hispanic). The primary outcome was use of ≥ 1 SGLT2i or GLP1ra medication. We used multivariable logistic regression to assess the interaction between payer and race/ethnicity adjusted for cardiovascular, socioeconomic, and healthcare access factors. We included 4997 adults, representing 24.8 million US adults annually with diabetes (mean age 63.6years, 48.8%female, 38.8%non-White; 33.5% private insurance, 56.8% Medicare, 9.8% Medicaid). In our fully adjusted model, White individuals with private insurance had significantly more medication use versus non-White individuals (16.1% vs 8.3%, p < 0.001), which was similar for Medicare beneficiaries but more attenuated (14.7% vs 11.0%, p = 0.04). Medication rates were similar among Medicaid beneficiaries (10.0% vs 9.0%, p = 0.74). Racial/ethnic disparities in novel diabetes medications were the largest among those with private insurance. There was no disparity among Medicaid enrollees, but overall prescription rates were the lowest. Given that disparities vary considerably by payer, differences in insurance coverage may account for the observed disparities in SGLT2i and GLP1ra use. Future studies are needed to assess racial/ethnic differences in novel diabetes use by insurance formulary restrictions and out-of-pocket cost-sharing.

Sociodemographic Factors of Asthma Prevalence and Costs Among Children and Adolescents in the United States, 2016-2021.

Asthma is a chronic condition with a high prevalence and cost of care among children and adolescents. While previous research described the association of sociodemographic factors with childhood asthma prevalence, there is limited knowledge of these factors' association with medical expenditures. In this study, we examined disparities in treated asthma prevalence and medical expenditures among US children and adolescents. Using nationally representative data from the 2016-2021 Medical Expenditures Panel Survey, we conducted a cross-sectional study of 2,365 children and adolescents (aged 0-17 y) with treated asthma compared with 40,497 children and adolescents without treated asthma. Treated asthma was defined as whether the child or adolescent had a medical event (emergency department visit, hospital inpatient stay, hospital outpatient visit, office-based medical visit, home health, and/or prescribed medicines) due to asthma. We controlled for sociodemographic factors of race and ethnicity, age, sex, health insurance coverage, family poverty status, and census region. We used 2-part models and generalized linear models to estimate annual per-person incremental medical expenditures associated with asthma. Children and adolescents with treated asthma were more likely than those without treated asthma to be non-Hispanic Black or Hispanic, male, and publicly insured. Children and adolescents with treated asthma had $3,362.56 in additional annual medical expenditures, of which $174.06 was out-of-pocket, compared with children and adolescents without treated asthma. The additional expenditures included $955.96 for prescribed medicines, $151.52 for emergency department visits, and $858.17 for office-based medical visits. Non-Hispanic Black children with treated asthma had significantly lower total ($2,721.28) and office-based visit expenditures ($803.19) than non-Hispanic White children with treated asthma. Disparities among children and adolescents in the US persist in treated asthma prevalence and associated medical expenditures by sociodemographic factors.

Health Care Expenditure in United States Adults With Heart Failure With and Without Diabetes

The health costs for heart failure (HF) among individuals with and without diabetes can help understand the conjoint burden of diabetes and HF. Using the 2008–2019 US national Medical Expenditure Panel Survey data including 2,019 adults with HF and a 2-part adjusted model, we estimated mean and adjusted incremental direct medical expenditures related to diabetes. The total direct expenditures for individuals with HF increased by 27%: $24,725 (95% confidence interval [CI]: $20,457-$28,993) in 2008-2009 to $31,426 (95% CI: $25,705-$37,147) in 2018-2019. The expenditures rose by 34% among those with diabetes. Inpatient costs represented the highest fraction of costs ∼ 43.3 % and were 8% higher among those with diabetes vs. those without diabetes. The drug costs accounted for 24% of all costs, increased by 44%, and were 86% higher among HF patients with diabetes vs. those without diabetes. The adjusted excess costs among individuals with HF and diabetes vs. HF without diabetes was $6,818 (95% CI: 2,241-11,395); the corresponding excess costs for drugs and medical costs other than drugs were $3,297 (95% CI: 2,168-4,426) and $3,554 (95% CI: -777-7,886). Among US adults with HF, the estimated adjusted total direct excess costs were $5.2 billion per year higher among individuals with diabetes vs. those without diabetes. In conclusion, diabetes is associated with substantially increased health care costs among patients with HF, suggesting the need for an integrated management of diabetes and HF.

Cost Analysis of Dropless Cataract Surgery Prophylaxis with Intracameral Antibiotics and Subconjunctival Steroids.

To determine whether dropless, injection-based cataract surgery prophylaxis with intracameral antibiotic and subconjunctival steroid may reduce healthcare system costs and patient out-of-pocket costs compared to topical medication regimens. United States national medical expenditures database. Retrospective cost analysis. Costs were analyzed for topical ophthalmics from the 2020 Medical Expenditure Panel Survey (MEPS) and for dropless medications from pharmaceutical invoices/catalogs. Main outcomes included system costs, from insurance and patient payments, and out-of-pocket costs for cataract surgery topical and dropless, injection-based prophylactic medication regimens, per eye and nationally. System costs for individual topical medications and same-class dropless, injection-based medications were compared using two-sided, one-sample t-tests. There were 583 prophylactic topical ophthalmic purchases in MEPS. Mean system costs per eye were $76.20 ± SD 39.07 for the lowest cost topical steroid (prednisolone) compared to $4.01 for the lowest cost subconjunctival steroid (triamcinolone acetonide) (p < 0.001). Per eye, the lowest cost dropless, injection-based regimen, at $15.91, results in an $87.99 (84.7%) reduction in overall healthcare costs and a $43.64 (100%) reduction in patient out-of-pocket costs relative to the lowest cost topical regimen ($103.90 ± 43.14 mean system cost and $43.64 ± 37.32 mean out-of-pocket cost per eye). Use of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce annual national healthcare system and out-of-pocket costs up to $450,000,000 and $225,000,000, respectively. An evidence-based cataract surgery prophylactic medication regimen of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce healthcare system and patient out-of-pocket costs in comparison to various topical regimens.

Health Care Expenditures and Use Associated with Hypertension Among U.S. Adults

IntroductionThis study seeks to estimate health care expenditures and use associated with hypertension, focusing on differences among racial and ethnic groups. MethodsData were from the 2019 Medical Expenditure Panel Survey, analyzed in 2023. The study sample included noninstitutionalized U.S. adults aged ≥18 years. Outcome variables were health care expenditures and events. Hypertension was determined by a self-reported diagnosis or diagnoses codes. Race and ethnicity were self-reported. A 2-part model was used to estimate expenditures associated with hypertension. A zero-inflated negative binomial model was used to estimate events associated with hypertension. Sampling designs were applied to generate nationally representative estimates. ResultsHypertension was associated with $2,759 (95% confidence interval [CI]: $2,039, $3,479) in health care expenditures and 10.3 (95% CI: 9.3, 11.3) health care events, including prescriptions filled, in 2019 per person. Compared with non-Hispanic White adults, hypertension-associated health care expenditures were significantly lower among Hispanic adults (difference: -$1,877; 95% CI: -$3,389, -$364) and Asian adults (difference: -$2,452; 95% CI: -$4,093, -$811), and hypertension-associated health care events were significantly lower among Hispanic adults (difference: -3.8; 95% CI: -6.1, -1.6) and non-Hispanic Asian adults (difference: -4.1; 95% CI: -6.9, -1.2). Differences between non-Hispanic White adults and non-Hispanic Black adults were not statistically significant in health care expenditures (difference: -$954; 95% CI: -$2,849, $941) and events (difference: 0.3; 95% CI: -2.1, 2.8). ConclusionsThis study reveals differences in health care expenditures and use associated with hypertension among racial and ethnic groups. Future studies are needed to examine potential drivers of these differences.

Association of Number of Comorbid Conditions and Pain among United States Adults.

Studies have explored the association of particular conditions, or combinations of conditions, and pain among specific populations. However, there is limited information regarding the association of the number of comorbid conditions, as well as other demographic, economic, health, and limitation variables, with pain among adults in the United States. This cross-sectional database study aimed to examine the relationships between number of comorbid conditions (including cancer, arthritis, joint pain, stroke, heart attack, angina, coronary heart disease, high cholesterol, high blood pressure, other heart diseases, diabetes, asthma, chronic bronchitis, and emphysema), demographic, economic, health, and limitation variables with pain among United States adults using 2021 Medical Expenditure Panel Survey data. A multivariable logistic model assessed the association between the number of comorbid conditions (≥6, 5, 4, 3, 2, 1, versus 0 conditions) and quite a bit/extreme (versus little/moderate) pain, adjusting for demographic, economic, health, and limitation variables. The study found that greater numbers of comorbid conditions were associated with higher odds of quite a bit or extreme pain. In addition, age, education, employment, income, overall health, regular physical activity, and three limitation variables were each associated with pain in the multivariable model. These findings offer insight into the association between number of comorbid conditions and other variables with pain and suggest areas where interventions may be helpful to help improve pain outcomes for United States adults.

Trends in direct health care costs among US adults with atherosclerotic cardiovascular disease with and without diabetes

ObjectivePopulation-based national data on the trends in expenditures related to coexisting atherosclerotic cardiovascular diseases (ASCVD) and diabetes is scarce. We assessed the trends in direct health care expenditures for ASCVD among individuals with and without diabetes, which can help to better define the burden of the co-occurrence of diabetes and ASCVD.MethodsWe used 12-year data (2008–2019) from the US national Medical Expenditure Panel Survey including 28,144 U.S individuals aged ≥ 18 years. Using a two-part model (adjusting for demographics, comorbidities and time), we estimated mean and adjusted incremental medical expenditures by diabetes status among individuals with ASCVD. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).ResultsThe total direct expenditures for individuals with ASCVD increased continuously by 30% from $14,713 (95% confidence interval (CI): $13,808–$15,619) in 2008–2009 to $19,145 (95% CI: $17,988–$20,301) in 2008–2019. Individuals with diabetes had a 1.5-fold higher mean expenditure that those without diabetes. A key driver of the observed increase in direct costs was prescription drug costs, which increased by 37% among all individuals with ASCVD. The increase in prescription drug costs was more pronounced among individuals with ASCVD and diabetes, in whom a 45% increase in costs was observed, from $5184 (95% CI: $4721–$5646) in 2008–2009 to $7501 (95% CI: $6678–$8325) in 2018–2019. Individuals with ASCVD and diabetes had $5563 (95% CI: $4643–$6483) higher direct incremental expenditures compared with those without diabetes, after adjusting for demographics and comorbidities. Among US adults with ASCVD, the estimated adjusted total direct excess medical expenditures were $42 billion per year among those with diabetes vs. those without diabetes.ConclusionsIn the setting of ASCVD, diabetes is associated with significantly increased health care costs, an increase that was driven by marked increase in medication costs.

Use Of High- And Low-Value Health Care Among US Adults, By Income, 2010-19.

Health care payment reforms in the US have aimed to encourage the use of high-value care while discouraging the use of low-value care. However, little is known about whether the use of high- and low-value care differs by income level. Using data from the 2010-19 Medical Expenditure Panel Survey, we examined the use of specified types of high- and low-value care by income level. We found that high-income adults were significantly more likely than low-income adults to use nearly all types of high-value care. Findings were consistent across age categories, although differences by income level in the use of high-value care were smaller among the elderly. Our analysis of differences in the use of low-value care had mixed results. Among nonelderly adults, significant differences between those with high and low incomes were found for five of nine low-value services, and among elderly adults, significant differences by income level were found for three of twelve low-value services. Understanding the mechanisms underlying these disparities is crucial to developing effective policies and interventions to ensure equitable access to high-value care and discourage low-value services for all patients, regardless of income.

Patient-Provider Communication and Access, Use, and Financial Burden of Care

IntroductionEffective patient-provider communication is a critical component of optimal patient care, but its potential impact on the delivery of health care services remains unclear. This study examines the association of patient-provider communication with access to care, health care utilization, and financial burden of care. MethodsUsing the 2013-2021 Medical Expenditure Panel Survey longitudinal data, the level of patient-provider communication was measured across four domains (attentive listening, clear explanation, respectfulness, and time allocation) as a primary independent variable, categorized into low, moderate, and high. A lagged dependent model was employed to examine the associations of patient-provider communication at baseline with subsequent access to care, health care utilization, and financial burden of care, controlling for baseline sample characteristics and outcomes measured at the baseline. Analysis was conducted in February 2024. ResultsAmong 28,955 analytic samples (representing 709,547,678 US adults), 5.3%, 50.2%, and 44.3% reported low, moderate, and high levels of patient-provider communication. Marginalized populations, including racial/ethnic minorities, those with low education and income, and those lacking insurance, were more likely to report low patient-provider communication. Compared with adults with high patient-provider communication, those with low patient-provider communication were more likely to encounter difficulties in accessing medical care (2.6 percentage points; 95% CI: 1.2-3.9), experience delays in obtaining necessary medical care (2.8 percentage points; 1.3-4.4), have emergency room visits (4.2 percentage points; 1.9-6.4), and face difficulties paying medical bills (4.0 percentage points; 2.2-5.8) in the subsequent year. ConclusionsEncouraging effective patient-provider communication is essential for advancing patient-centered care and mitigating health inequities.