Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes
Abstract Background Chargemaster prices are the list prices that providers and health systems assign to each of their medical services in the US. These charges are often several factors of magnitude higher than those extended to individuals with either private or public insurance, however, these lis...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Health Economics Review |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13561-024-00486-7 |
| _version_ | 1797266950247677952 |
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| author | Sebastian Linde Leonard E. Egede |
| author_facet | Sebastian Linde Leonard E. Egede |
| author_sort | Sebastian Linde |
| collection | DOAJ |
| description | Abstract Background Chargemaster prices are the list prices that providers and health systems assign to each of their medical services in the US. These charges are often several factors of magnitude higher than those extended to individuals with either private or public insurance, however, these list prices are billed in full to uninsured patients, putting them at increased risk of catastrophic health expenditures (CHE). The objective of this study was to examine the risk of CHE across insurance status, diabetes diagnosis and to examine disparity gaps across race/ethnicity. Methods We perform a retrospective observational study on a nationally representative cohort of adult patients from the Medical Expenditure Panel Survey for the years 2002–2017. Using logistic regression models we estimate the risk of CHE across insurance status, diabetes diagnosis and explore disparity gaps across race/ethnicity. Results Our fully adjusted results show that the relative odds of having CHE if uninsured is 5.9 (p < 0.01) compared to if insured, and 1.1 (p < 0.01) for patients with a diabetes diagnosis (compared to those without one). We note significant interactions between insurance status and diabetes diagnosis, with uninsured patients with a diabetes diagnosis being 9.5 times (p < 0.01) more likely to experience CHE than insured patients without a diabetes diagnosis. In terms of racial/ethnic disparities, we find that among the uninsured, non-Hispanic blacks are 13% (p < 0.05), and Hispanics 14.2% (p < 0.05), more likely to experience CHE than non-Hispanic whites. Among uninsured patients with diabetes, we further find that Hispanic patients are 39.3% (p < 0.05) more likely to have CHE than non-Hispanic white patients. Conclusions Our findings indicate that uninsured patients with diabetes are at significantly elevated risks for CHE. These risks are further found to be disproportionately higher among uninsured racial/ethnic minorities, suggesting that CHE may present a channel through which structural economic and health disparities are perpetuated. |
| first_indexed | 2024-04-25T01:08:50Z |
| format | Article |
| id | doaj.art-e7dc72790e124518821a330826cdad78 |
| institution | Directory Open Access Journal |
| issn | 2191-1991 |
| language | English |
| last_indexed | 2024-04-25T01:08:50Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Health Economics Review |
| spelling | doaj.art-e7dc72790e124518821a330826cdad782024-03-10T12:05:35ZengBMCHealth Economics Review2191-19912024-03-0114111110.1186/s13561-024-00486-7Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetesSebastian Linde0Leonard E. Egede1Department of Health Policy & Management, Texas A&M School of Public HealthDepartment of Medicine, Division of General Internal Medicine, Medical College of WisconsinAbstract Background Chargemaster prices are the list prices that providers and health systems assign to each of their medical services in the US. These charges are often several factors of magnitude higher than those extended to individuals with either private or public insurance, however, these list prices are billed in full to uninsured patients, putting them at increased risk of catastrophic health expenditures (CHE). The objective of this study was to examine the risk of CHE across insurance status, diabetes diagnosis and to examine disparity gaps across race/ethnicity. Methods We perform a retrospective observational study on a nationally representative cohort of adult patients from the Medical Expenditure Panel Survey for the years 2002–2017. Using logistic regression models we estimate the risk of CHE across insurance status, diabetes diagnosis and explore disparity gaps across race/ethnicity. Results Our fully adjusted results show that the relative odds of having CHE if uninsured is 5.9 (p < 0.01) compared to if insured, and 1.1 (p < 0.01) for patients with a diabetes diagnosis (compared to those without one). We note significant interactions between insurance status and diabetes diagnosis, with uninsured patients with a diabetes diagnosis being 9.5 times (p < 0.01) more likely to experience CHE than insured patients without a diabetes diagnosis. In terms of racial/ethnic disparities, we find that among the uninsured, non-Hispanic blacks are 13% (p < 0.05), and Hispanics 14.2% (p < 0.05), more likely to experience CHE than non-Hispanic whites. Among uninsured patients with diabetes, we further find that Hispanic patients are 39.3% (p < 0.05) more likely to have CHE than non-Hispanic white patients. Conclusions Our findings indicate that uninsured patients with diabetes are at significantly elevated risks for CHE. These risks are further found to be disproportionately higher among uninsured racial/ethnic minorities, suggesting that CHE may present a channel through which structural economic and health disparities are perpetuated.https://doi.org/10.1186/s13561-024-00486-7Catastrophic Health ExpendituresChargemaster PricesDiabetesUninsuredRacial DisparitiesStructural Inequity |
| spellingShingle | Sebastian Linde Leonard E. Egede Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes Health Economics Review Catastrophic Health Expenditures Chargemaster Prices Diabetes Uninsured Racial Disparities Structural Inequity |
| title | Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes |
| title_full | Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes |
| title_fullStr | Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes |
| title_full_unstemmed | Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes |
| title_short | Catastrophic health expenditures: a disproportionate risk in uninsured ethnic minorities with diabetes |
| title_sort | catastrophic health expenditures a disproportionate risk in uninsured ethnic minorities with diabetes |
| topic | Catastrophic Health Expenditures Chargemaster Prices Diabetes Uninsured Racial Disparities Structural Inequity |
| url | https://doi.org/10.1186/s13561-024-00486-7 |
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