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Out-of-Pocket Health Care Expenditures Among United States Children: Parental Perceptions and Past-Year Expenditures, 2016 to 2017.

Authors
  • Jones, Jessica R1
  • Kogan, Michael D2
  • Ghandour, Reem M2
  • Minkovitz, Cynthia S3
  • 1 Health Resources and Services Administration, Maternal and Child Health Bureau (JR Jones, MD Kogan, and RM Ghandour), Rockville, Md. Electronic address: [email protected]
  • 2 Health Resources and Services Administration, Maternal and Child Health Bureau (JR Jones, MD Kogan, and RM Ghandour), Rockville, Md.
  • 3 Departments of Population, Family and Reproductive Health and Pediatrics, Johns Hopkins Bloomberg School of Public Health (CS Minkovitz), Baltimore, Md.
Type
Published Article
Journal
Academic pediatrics
Publication Date
Apr 01, 2021
Volume
21
Issue
3
Pages
480–487
Identifiers
DOI: 10.1016/j.acap.2020.11.014
PMID: 33221493
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To examine the association between parental perceptions of out-of-pocket (OOP) health care costs for their child and the total amount of OOP health care expenditures for that child during the past year. We used data from the 2016 and 2017 National Surveys of Children's Health, cross-sectional, parent-reported, and nationally representative surveys of noninstitutionalized US children, ages 0 to 17 years. We conducted bivariate analyses to assess characteristics associated with the amount of OOP expenditures and parental perceptions of these costs. We estimated adjusted prevalence ratios for parental perceptions of OOP costs using logistic regression. Based on parent report, nearly two thirds (65.7%) of children incurred some amount of past-year OOP expenditures, with 13.3% of children incurring expenditures of ≥$1000. Parents reported that costs were unreasonable for 35.3% of children with past-year expenditures. The amount of OOP spending was associated with parents' perceptions that costs were unreasonable, with 16.5% of those with $1 to 249 in expenditures reporting unreasonable costs compared to 77.5% of those with >$5,000 in expenditures (P < .05). In adjusted analyses, high OOP expenditures, non-Hispanic white race/ethnicity, lack of health insurance, low household income, parental education levels less than a college degree, and foreign-born nativity status were associated with reports of unreasonable costs (P < .05). This study demonstrates an association between attitudinal and economic measures of health care expenditures for children while demonstrating differences in the perception of costs by measures of family economic vulnerability. Results may inform efforts to assess adequacy of health insurance coverage. Copyright © 2021. Published by Elsevier Inc.

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