The Percentage of Patients Experiencing Financial Strain Depends on the Screening Measure: Evidence From a Cross-Sectional Survey of Adult Members of an Integrated Healthcare Delivery System.

IF 3 Q1 PRIMARY HEALTH CARE
Emma L Tucher, Richard W Grant, Nancy P Gordon
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Abstract

Objectives: Financial strain has important consequences for patients, providers, and health care systems. However, there is currently no gold standard measure to screen for financial strain. This study compared the performance of 3 single-item screeners using a composite measure of financial strain as a "gold standard."

Methods: We conducted a secondary analysis of unweighted data from a 2021 survey of Kaiser Permanente Northern California health plan members comparing the percentages of adults who experienced financial strain based on 3 general single-item screeners, a screener specific to medical and dental health care use, and a composite financial strain measure. The study sample was comprised of 2734 non-Medicaid insured adults who answered all financial strain questions. Kappa statistics evaluating agreement of the 3 general screeners with the composite measure were calculated for the sample overall, by age group, and within age group, by 4 levels of income and 4 racial/ethnic subgroups.

Results: Among 947 adults aged 35 to 65, 30.7% had just enough money or not enough money to make ends meet, 23.3% had a somewhat hard or hard time paying for basics, 18.8% had trouble paying for ≥1 type of expense, 20.5% had delayed/used less medical/dental care, and 41.5% had experienced financial strain based on the composite measure. Among 1787 adults aged 66 to 85, the percentages who screened positive on these measures were 22.7%, 19.4%, 12.9%, 19.8%, and 34.4%, respectively. Across the sample, by income categories and racial/ethnic groups, the making ends meet screener identified higher percentages of adults experiencing financial strain and performed better when compared with the composite measure than the hard to pay for the very basics and trouble paying for expenses screeners. Overall, substantial decreases in the percentages of adults who screened positive on the financial strain measures were seen as level of income increased. Within income categories, middle-aged adults were more likely than older adults to have experienced financial strain based on the composite and general single-item screeners.

Conclusions: As social risk screening becomes part of the standard of care, it will be important to assess how well different brief screeners for financial strain perform with diverse patient populations.

经历经济压力的患者比例取决于筛查措施:对综合医疗服务系统成年成员的横断面调查证据。
目标:财务紧张对患者、医疗服务提供者和医疗系统都有重要影响。然而,目前还没有筛查财务压力的黄金标准。本研究以财务压力的综合衡量标准作为 "黄金标准",比较了 3 种单项筛选器的性能:我们对 2021 年对北加州凯撒医疗保险计划成员进行的一项调查中的非加权数据进行了二次分析,比较了根据 3 种通用单项筛选器、一种专门针对医疗和牙科保健使用的筛选器以及一种综合财务压力测量方法筛选出的经历过财务压力的成年人的百分比。研究样本由 2734 名未参加医疗保险的成年人组成,他们回答了所有经济压力问题。研究人员计算了样本总体、各年龄组以及各年龄组内 4 个收入水平和 4 个种族/民族亚群的卡帕统计数据,以评估 3 个一般筛查指标与综合测量指标的一致性:在 947 名 35 至 65 岁的成年人中,30.7% 的人收入仅够糊口或入不敷出,23.3% 的人支付基本生活费用有些困难或很困难,18.8% 的人支付≥1 种费用有困难,20.5% 的人推迟/减少使用医疗/牙科护理,41.5% 的人根据综合衡量标准经历过经济紧张。在 1,787 名 66 至 85 岁的成年人中,这些指标呈阳性的百分比分别为 22.7%、19.4%、12.9%、19.8% 和 34.4%。在所有样本中,按收入类别和种族/民族群体划分,"入不敷出 "筛选器识别出的经历财务紧张的成年人比例较高,与综合测量相比,"难以支付最基本的费用 "和 "难以支付开支 "筛选器的表现更好。总体而言,随着收入水平的提高,在经济压力测评中呈阳性的成年人比例大幅下降。在收入类别中,中年人比老年人更有可能在综合筛选和一般单项筛选中经历财务紧张:随着社会风险筛查成为医疗标准的一部分,评估不同的财务压力简易筛查方法在不同患者群体中的表现将非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.80
自引率
2.80%
发文量
183
审稿时长
15 weeks
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