■美国人面临高额的自付医疗费用,产生财务压力和债务。
■了解家庭对他们不同意或负担不起的医疗账单的反应。
■使用2023年8月14日至10月14日进行的调查进行了一项回顾性队列研究。该研究包括来自理解美国研究(UAS)的成人(年龄≥18岁)调查受访者的随机样本。参与者的答复被加权为具有全国代表性。分析时间为2023年11月3日至2024年1月8日。
■受访者报告说,如果他们的家庭收到了他们在过去12个月中负担不起或不同意的医疗账单,如果有人就他们的担忧联系了账单办公室。那些接触过的人被问及他们的经历,那些没有接触过的人被问及为什么。
■调查已发送给1233UAS小组成员,其中1135人完成了调查,合作率为92.1%。总的来说,在1135名受访者中,五分之一的人收到了他们不同意或负担不起的医疗账单。主要的账单来源是医生办公室(66[34.6%]),急诊室或紧急护理(22[19.9%]),和医院(31[15.3%]),136名受访者(61.5%)联系账单办公室以解决他们的担忧。性格外向,性格不那么讨人喜欢,增加了伸出援手的可能性。没有大学学位的受访者,金融素养较低,没有保险的人不太可能联系账单办公室。在那些没有伸出援手的人中,55(86.1%)报告说他们认为这不会有所作为。在那些伸出援手的人中,37(25.7%)实现了账单更正,更好的理解(16[18.2%]),付款计划(18[15.5%]),价格下跌(17[15.2%]),财政援助(10[8.1%]),和/或取消账单(6[7.3%]),32人(21.8%)表示问题未解决,23.8%表示没有变化。这些结果与受访者对账单的担忧以及75.8%的受访者就负担不起的账单达成一致,73.7%的人认为有错误,61.8%的谈判人员价格下跌。
■这项针对美国代表性患者样本的横断面调查发现,大多数自我主张的受访者实现了账单更正和付款减免。自我宣传的差异可能会加剧医疗债务负担方面的社会经济不平等,作为那些受教育程度较低的人,金融素养较低,没有保险的人不太可能自我辩护。简化行政负担或将其从患者转移到计费临床医生的政策可能会解决这些差异。
UNASSIGNED: People in the US face high out-of-pocket medical expenses, yielding financial strain and debt.
UNASSIGNED: To understand how households respond to medical bills they disagree with or cannot afford.
UNASSIGNED: A retrospective cohort study was carried out using a survey fielded between August 14 and October 14, 2023. The study included a random sample of adult (aged ≥18 years) survey respondents from the Understanding America Study (UAS). Participant responses were weighted to be nationally representative. The analysis took place from November 3, 2023, through January 8, 2024.
UNASSIGNED: Respondents reported if their household received a medical bill that they could not afford or did not agree with in the prior 12 months, and if anyone contacted the billing office regarding their concerns. Those who did reach out were asked about their experience and those who did not were asked why.
UNASSIGNED: The survey was sent to 1233 UAS panelists, of which 1135 completed the survey, a 92.1% cooperation rate. Overall, 1 in 5 of the 1135 respondents received a medical bill that they disagreed with or could not afford. Leading bill sources were physician offices (66 [34.6%]), emergency room or urgent care (22 [19.9%]), and hospitals (31 [15.3%]), and 136 respondents (61.5%) contacted the billing office to address their concern. A more extroverted and less agreeable personality increased likelihood of reaching out. Respondents without a college degree, lower financial literacy, and the uninsured were less likely to contact a billing office. Among those who did not reach out, 55 (86.1%) reported that they did not think it would make a difference. Of those who reached out, 37 (25.7%) achieved bill corrections, better understanding (16 [18.2%]), payment plans (18 [15.5%]), price drop (17 [15.2%]), financial assistance (10 [8.1%]), and/or bill cancellation (6 [7.3%]), while 32 (21.8%) said that the issue was unresolved and 23.8% reported no change. These outcomes aligned well with respondents\' billing concerns with financial relief for 75.8% of respondents reaching out about an unaffordable bill, bill corrections for 73.7% of those who thought there was mistake, and a price drop for 61.8% of those who negotiated.
UNASSIGNED: This cross-sectional survey of a representative sample of patients in the US found that most respondents who self-advocated achieved bill corrections and payment relief. Differences in self-advocacy may be exacerbating socioeconomic inequalities in medical debt burden, as those with less education, lower financial literacy, and the uninsured were less likely to self-advocate. Policies that streamline the administrative burden or shift it from patients to the billing clinician may counter these disparities.