Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Abstract

View the peer-reviewed version (peerj.com/articles/587), which is the preferred citable publication unless you specifically need to cite this preprint.Park MD, Bhattacharya J, Park K. 2014. Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting. PeerJ 2:e587 https://doi.org/10.7717/peerj.587Di ff e r e n c e s i n h e a l t h c a r e e x p e n d i t u r e s f o r i n fl a mma t o r y b o we l d i s e a s e b y i n s u r a n c e s t a t u s , i n c o me , a n d c l i n i c a l c a r e s e t t i n g Ba c k g r o u n d : S o c i o e c o n o mi c f a c t o r s a n d i n s u r a n c e s t a t u s h a v e n o t b e e n c o r r e l a t e d wi t h d i ff e r e n t i a l u s e o f h e a l t h c a r e s e r v i c e s i n i n fl a mma t o r y b o we l d i s e a s e ( I B D) . Ai m: T o d e s c r i b e I B D-r e l a t e d e x p e n d i t u r e s b a s e d o n i n s u r a n c e a n d h o u s e h o l d i n c o me wi t h t h e u s e o f i n p a t i e n t , o u t p a t i e n t , e me r g e n c y , a n d o ffi c e -b a s e d s e r v i c e s , a n d p r e s c r i b e d me d i c a t i o n s i n t h e Un i t e d S t a t e s ( US ) . Me t h o d s :We e v a l u a t e d t h e Me d i c a l E x p e n d i t u r e P a n e l S u r v e y f r o m 1 9 9 6 t o 2 0 1 1 o f i n d i v i d u a l s wi t h Cr o h n ' s d i s e a s e ( CD) o r u l c e r a t i v e c o l i t i s ( UC) . Na t i o n a l l ywe i g h t e d me a n s , p r o p o r t i o n s , a n d mu l t i v a r i a t e r e g r e s s i o n mo d e l s e x a mi n e d t h e r e l a t i o n s h i p s b e t we e n i n c o me a n d i n s u r a n c e s t a t u s wi t h e x p e n d i t u r e s . Re s u l t s : A n n u a l p e r c a p i t a me a n e x p e n d i t u r e s f o r CD, UC, a n d a l l I B D we r e $ 1 0 , 3 6 4 ( N= 2 3 8 ) , $ 7 , 8 2 7 ( N= 9 5 ) , a n d $ 9 , 5 2 8 , r e s p e c t i v e l y , s i g n i fi c a n t l y h i g h e r t h a n n o n -I B D ( $ 4 , 3 1 4 , N= 2 7 6 , 3 7 2 , p < 0 . 0 5 ) . P u b l i c l y i n s u r e d p a t i e n t s i n c u r r e d t h e h i g h e s t c o s t s ( $ 1 8 , 0 6 7 ) , o v e r p r i v a t e l y i n s u r e d ( $ 8 , 0 1 4 , p < 0 . 0 5 ) o r u n i n s u r e d p a t i e n t s ( $ 5 , 1 2 9 , p < 0 . 5 ) . A mo n g a l l I B D p a t i e n t s , i n p a t i e n t c a r e c o mp o s e d t h e h i g h e s t p r o p o r t i o n o f c o s t s ( $ 3 , 3 9 2 , p < . 5 ) . I n p a t i e n t c o s t s we r e d i s p r o p o r t i o n a t e l y h i g h e rf o r p u b l i c l y i n s u r e d p a t i e n t s . P u b l i c i n s u r a n c e h a d h i g h e r o d d s o f t o t a l c o s t s t h a n p r i v a t e ( OR 2 . 1 3 , CI 1 . 0 8 -4 . 1 9 ) o r n o i n s u r a n c e ( OR 4 . 9 4 , CI 1 . 2 6 -1 9 . 4 7 ) , wi t h i n c r e a s e d o d d s f o r i n p a t i e n t a n d e me r g e n c y c a r e . P r i v a t e i n s u r a n c e h a d h i g h e r c o s t s a s s o c i a t e d wi t h o u t p a t i e n t c a r e , o ffi c e -b a s e d c a r e , a n d p r e s c r i b e d me d i c i n e s ....

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