Out‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States

Abstract Background Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out‐of‐pocket healthcare costs on patients with HF and their families. Methods and Results In the Medical Expenditure Panel Survey (MEPS), we identified all families with ≥1 adult member with HF during 2014 – 2018. Total out‐of‐pocket healthcare expenditures included yearly care‐specific costs and insurance premiums. We evaluated two outcomes of financial toxicity: (1) high financial burden – total out‐of‐pocket healthcare expense to post‐subsistence income of >20%, and (2) catastrophic financial burden with the rate of >40% ‐ a bankrupting expense defined by the WHO. There were 788 families in MEPS with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out‐of‐pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%‐18%) of families experienced a high burden and 5% (95% CI, 3%‐6%) experienced a catastrophic burden. Among the two‐fifths of families considered low‐income, 24% (95% CI, 18%‐30%) experienced a high financial burden, while 10% (95% CI, 6%‐14%) experienced a catastrophic burden. Low‐income families had 4‐fold greater risk‐adjusted odds of high (OR=3.9, 95% CI, 2.3–6.6), and 14‐fold greater risk‐adjusted odds of catastrophic financial burden (OR=14.2, 95% CI, 5.1–39.5) compared with middle/high income families. Conclusions Patients with HF and their families experience large out‐of‐pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low‐income families.

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PERCENTAGE OF UNINSURED CHILDREN HAS INCREASED

PEDIATRICS ◽

10.1542/peds.88.5.1051 ◽

1991 ◽

Vol 88 (5) ◽

pp. 1051-1051

Author(s):

STUDENT

Keyword(s):

Public Health ◽

United States ◽

Health Care ◽

Low Income ◽

Health Care Policy ◽

The United States ◽

Public Health Insurance ◽

Care Policy ◽

Low Income Families ◽

Uninsured Children

The proportion of children in the United States without private or public health insurance increased from roughly 13 percent to 18 percent between 1977 and 1987, according to a new study by the Agency for Health Care Policy and Research (AHCPR). The growth in the proportion of uninsured children in poor and low-income families over the decade was even more dramatic—it rose from 21 percent to 31 percent.

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Food Stamp Program Effects on Availability Of Food Nutrients for Low Income Families In the Southern Region of the United States

Journal of Agricultural and Applied Economics ◽

10.1017/s0081305200015120 ◽

1979 ◽

Vol 11 (2) ◽

pp. 113-120 ◽

Cited By ~ 11

Author(s):

W. Keith Scearce ◽

Robert B. Jensen

Keyword(s):

United States ◽

Low Income ◽

The United States ◽

Southern Region ◽

Food Stamp ◽

Food Stamp Program ◽

Nutritional Improvement ◽

Program Effects ◽

Low Income Families ◽

Low Income Households

The food stamp program, as enacted into law in 1964, was intended to improve the diet of low income households, but whether the program resulted in a nutritional improvement remains a controversial question. Several studies have evaluated the nutritional impact of the food stamp program on participant households. In general, the study findings do not conclusively resolve the question of nutritional improvement for participant families. Studies of California families showed some nutritional improvements among food stamp recipients in comparison with nonrecipients [7, 8]. A study in Pennsylvania showed no nutritional improvements, except in temporary periods of cash shortage [9].

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US election could affect remittances to Latin America

Emerald Expert Briefings ◽

10.1108/oxan-db213876 ◽

2016 ◽

Keyword(s):

United States ◽

Latin America ◽

Low Income ◽

Positive Impact ◽

The United States ◽

Content Type ◽

The Caribbean ◽

Low Income Families

Subject Growing remittances to Latin America. Significance Family remittances to Latin America and the Caribbean (LAC) have been growing strongly in a year when immigration has become a central and controversial election issue in the United States. Impacts Strong remittance growth will have a positive impact on millions of low-income families in the region. A Trump presidency could lead to reduced LAC-US migration and a tax on remittances, probably slowing growth in 2017-18. LAC migrants and their families are set to benefit further from an expected continuing fall in sending costs.

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Housing hardship and energy insecurity among native-born and immigrant low-income families with children in the United States

Journal of Children and Poverty ◽

10.1080/10796126.2016.1148672 ◽

2016 ◽

Vol 22 (2) ◽

pp. 77-92 ◽

Cited By ~ 19

Author(s):

Diana Hernández ◽

Yang Jiang ◽

Daniel Carrión ◽

Douglas Phillips ◽

Yumiko Aratani

Keyword(s):

United States ◽

Low Income ◽

The United States ◽

Low Income Families ◽

Families With Children

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Impact of Domestic Food Programs on Nutrient Intake of Low-Income Persons in the United States

Journal of Agricultural and Applied Economics ◽

10.1017/s0081305200016101 ◽

1983 ◽

Vol 15 (1) ◽

pp. 155-163 ◽

Cited By ~ 10

Author(s):

Jean-Paul Chavas ◽

Keith O. Keplinger

Keyword(s):

United States ◽

Low Income ◽

Nutrient Intake ◽

Agricultural Sector ◽

The United States ◽

Food Programs ◽

Low Income Families ◽

Primary Focus ◽

The Needy ◽

Domestic Food

Domestic food programs in the United States originated in the 1930s, primarily in response to the needs of the agricultural sector. They served as a disposal mechanism for agricultural surpluses and were designed to stimulate demand. However, the nature of U.S. food programs has changed significantly during the last two decades. Out of a growing concern for the poor and the needy, their primary focus has become the improvement of the nutritional status of low-income families (Paarlberg, pp. 99-102.).

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Quality of Child Care as an Aspect of Family and Child Care Policy in the United States

PEDIATRICS ◽

10.1542/peds.91.1.182 ◽

1993 ◽

Vol 91 (1) ◽

pp. 182-188

Author(s):

Sandra Scarr ◽

Deborah Phillips ◽

Kathleen McCartney ◽

Martha Abbott-Shim

Keyword(s):

United States ◽

Child Care ◽

Low Income ◽

The United States ◽

Child Care Policy ◽

Care Policy ◽

Working Families ◽

Low Income Families ◽

The Impact

The quality of child care services in the United States should be understood within a context of child care policy at the federal and state levels. Similarly, child care policy needs to be examined within the larger context of family-support policies that do or do not include parental leaves to care for infants (and other dependent family members) and family allowances that spread the financial burdens of parenthood. Maynard and McGinnis1 presented a comprehensive look at the current and predictable policies that, at federal and state levels, affect working families and their children. They note the many problems in our "patchwork" system of child care—problems of insufficient attention to quality and insufficient supply for low-income families. Recent legislation is a step toward improving the ability of low-income families to pay for child care (by subsidizing that part of the cost of such care which exceeds 15% rather than 20% of the family income) and some steps toward training caregivers and improving regulations. They note the seeming political impasse over parental leaves, even unpaid leaves, and the impact of this lack of policy on the unmet need for early infant care. We should step back from the current morass of family and child care policies in the United States and look at what other nations have done and continue to do for their working families. By comparison with other industrialized countries in the world, the United States neglects essential provisions that make it possible for parents in other countries to afford to rear children and to find and afford quality child care for their children.

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Universal Basic Income in the United States and Advanced Countries

Annual Review of Economics ◽

10.1146/annurev-economics-080218-030237 ◽

2019 ◽

Vol 11 (1) ◽

pp. 929-958 ◽

Cited By ~ 12

Author(s):

Hilary Hoynes ◽

Jesse Rothstein

Keyword(s):

United States ◽

Low Income ◽

The United States ◽

Pilot Studies ◽

Middle Income ◽

Transfer Programs ◽

Poor Households ◽

Advanced Economies ◽

Low Income Families

We discuss the potential role of universal basic incomes (UBIs) in advanced countries. A feature of advanced economies that distinguishes them from developing countries is the existence of well-developed, if often incomplete, safety nets. We develop a framework for describing transfer programs that is flexible enough to encompass most existing programs as well as UBIs, and we use this framework to compare various UBIs to the existing constellation of programs in the United States. A UBI would direct much larger shares of transfers to childless, nonelderly, nondisabled households than existing programs, and much more to middle-income rather than poor households. A UBI large enough to increase transfers to low-income families would be enormously expensive. We review the labor supply literature for evidence on the likely impacts of a UBI. We argue that the ongoing UBI pilot studies will do little to resolve the major outstanding questions.

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Dentistry and Childhood Poverty in the United States

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.37.1.q556103582275g23 ◽

2012 ◽

Vol 37 (1) ◽

pp. 113-116 ◽

Cited By ~ 1

Author(s):

HB Waldman ◽

D Cannella ◽

SP Perlman

Keyword(s):

United States ◽

Health Insurance ◽

Low Income ◽

The United States ◽

Dental Services ◽

Childhood Poverty ◽

Low Income Families ◽

The Impact ◽

Localized Levels

The proportion and numbers of children living in low income families and without health insurance continues to increase. The magnitude of these problems is considered at localized levels in terms of the impact on the use of dental services.

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