Disparities in Child & Family Health Care Expenditures

儿童的差异

• 批准号: 6506497
• 负责人: Paul Newacheck
• 金额: $ 17.11万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-07-01 至 2004-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6506497
• 关键词: children; family; health care cost /financing; health care service; health insurance; health services research tag; human data; income; pediatrics; racial /ethnic difference

DESCRIPTION: Specific Aims: Prompted by a series of federal initiatives, the health services research community is focused on identifying and documenting disparities in health and health care among racial/ethnic groups as well as across the income distribution. However, little of this growing body of work has addressed disparities of the economic burden of illness. The objective of this project is to examine the extent to which disparities exist in out-of-pocket health care expenses for children and families, and the role that health insurance plays in reducing or eliminating disparities. The specific aims of this project are: 1) Do disparities exist in out-of-pocket expenditures among children and families with different incomes? 2) Do disparities exist in out-of-pocket expenditures among children and families with different racial/ethnic characteristics? 3) To what extent does health insurance coverage mediate these disparities? and 4) To what extent have there been changes since 1977 in disparities in out-of-pocket expenditures for children and families with different incomes and different race/ethnic characteristics? Research Design and Methods: This study will utilize three national health care expenditures surveys conducted for the Agency for Healthcare Research and Quality and its predecessor agencies: the 1977 National Medical Care Expenditure Survey, the 1987 National Medical Expenditure Survey, and the 1997 Medical Expenditure Panel Survey. We will conduct all analyses using families and then sample children as the unit of analysis. A unique aspect of our study is the analysis of expenditure data at the individual child level and the family level. In all analyses financial burden, the dependent variable, is operationalized in two ways: 1) as the ratio of annual out-of-pocket health care expenses to annual family income multiplied by 100 and 2) whether out-of-pocket health care expenses reach certain catastrophic thresholds (e.g. 15% of family income). To address specific aims 1 and 2 above, a series of cross-sectional analyses, incorporating bivariate and multivariate methods, will be conducted using the 1997 MEPS. Bivariate analysis will be used to assess whether disparities exist on an unadjusted basis. Multivariate analysis, including linear and logistic regression, will be used to assess whether disparities exist on an adjusted basis. Also using the 1997 MEPS, a hierarchical regression analysis will be used to assess whether health insurance is associated with a diminution of income and racial/ethnic disparities in financial burden (aim 3). For the trend analysis (aim 4), a regression-based differences-in-differences approach will be employed to assess changes in disparities over time. This analysis will incorporate pooled data from all three surveys. At least 3 products are expected: a paper describing disparities in financial burden across income and among racial/ethnic groups using family level data; a paper aimed at a pediatric audience that describes disparities using children as the unit of analysis; and a paper describing changes in the distribution of financial burden across income and race/ethnicity from 1977-97.

描述：具体目的：由一系列联邦计划提示 卫生服务研究社区的重点是识别和记录 种族/族裔以及 跨收入分配。但是，这种不断增长的工作很少 已经解决了疾病经济负担的差异。目的 该项目是为了检查在其中存在的差异的程度 儿童和家庭的自付外医疗保健费用，以及该角色 这种健康保险在减少或消除差异方面发挥了作用。这 该项目的具体目的是：1）是否有差距存在于自付端。 有不同收入的儿童和家庭的支出？ 2）做 儿童和家庭的自付支出中存在差异 具有不同的种族/种族特征？ 3）健康在多大程度上 保险范围调解了这些差异？ 4）在多大程度上 自1977年以来，自付费支出的差异就发生了变化 儿童和家庭有不同的收入和不同的种族/族裔 特征？研究设计和方法：本研究将使用三个 为该机构进行的国家卫生保健支出调查 医疗研究和质量及其前身机构：1977年 国家医疗保健支出调查，1987年国家医疗 支出调查和1997年的医疗支出小组调查。我们将 使用家庭进行所有分析，然后将儿童作为单位进行采样 分析。我们研究的一个独特方面是分析支出数据 个体儿童级别和家庭层面。在所有分析中 负担是因变量，以两种方式进行操作：1） 年度自付医疗保健费用与年度家庭收入的比率 乘以100和2）是否有自付医疗保健费用到达 某些灾难性阈值（例如，家庭收入的15％）。解决 上面的特定目的1和2，一系列横截面分析， 合并双变量和多元方法将使用 1997 MEPS。双变量分析将用于评估差异是否 不调整的基础存在。多元分析，包括线性和 逻辑回归将用于评估是否存在差距 调整后的基础。还使用1997 MEP，层次回归分析 将用于评估健康保险是否与 财务负担的收入和种族/种族差异的减少（目标 3）。对于趋势分析（AIM 4），基于回归的差异差异 将采用方法来评估差异的变化 时间。该分析将包含来自所有三项调查的汇总数据。在 预期至少有3种产品：一篇描述财务差异的论文 使用家庭级别数据跨收入以及种族/族裔群体的负担；一个 针对儿科受众的纸张，描述了使用孩子的差异 作为分析单位；以及描述分布变化的论文 从1977 - 97年开始，收入和种族/种族的财务负担。