Cost-Related Non-Utilization in Healthcare
Uploaded by
National Press FoundationCost-Related Non-Utilization in Healthcare
Uploaded by
National Press FoundationBeyond the average
Eberechukwu Onukwugha, MS, PhD
Associate Professor
Department of Pharmaceutical Health Services Research
University of Maryland School of Pharmacy
Adults Who Cited Cost as a Reason for Skipping Prescriptions or Doses, 2016
Percent
United States:
40
14% or 33%
33
30
Other countries: 2% to 10%
20
14
10
10
9
6 6
2 4
3 3 4
0
United Germany Norway France Netherlands Sweden Australia Switzerland Canada United States, United States,
Kingdom insured _x000d_not
continuously insured
in past year continuously
in past year
Data: 2016 Commonwealth Fund International Health Policy Survey of Adults in 11 Countries.
2
Source: D. O. Sarnak, D. Squires, and G. Kuzmak, Paying for Prescription Drugs Around the World: Why Is the U.S. an
Outlier? The Commonwealth Fund, October 2017.
Cost-related non-utilization (CRNU)
• Two approaches to define CRNU
• “Needed to see a doctor but could not
because of cost”
• “Did not take medication as prescribed
because of cost”
3
Cost-related non-utilization (CRNU)
Two categories: physician visits and Rx
30
25
20
15
12.7
10
7.4
0
Cost-related non-utilization, physician visits Cost-related non-utilization, prescription meds
Latinx
Onukwugha E, McRae J, Camelo Castillo W. Cost-related Non-utilization of Health Services and Self-Perceived
Reactions to Race. Ethn Dis. 2020. 30(3):399-410.
4
CRNU: stratified by race/ethnicity
Two categories: physician visits and Rx
30
25.7
25
20 18.5
15 13.8
12.7 12.9
10 9.4
7.4
5.8
5
0
Cost-related non-utilization, physician visits Cost-related non-utilization, prescription meds
All White Black Latinx
Onukwugha E, McRae J, Camelo Castillo W. Cost-related Non-utilization of Health Services and Self-Perceived
Reactions to Race. Ethn Dis. 2020. 30(3):399-410.
5
What next?
• Appropriate interpretation of group
differences requires “contextual specificity”1
• Engagement with stakeholders
• What is available?
– Datasets
– Measures
– Methods
1
Panch et al. Artificial intelligence and algorithmic bias: implications for health systems.6
J Glob Health. 2019 Dec; 9(2): 020318.
Record Linkage
• Joining data from multiple sources via
common identifying variables
– Patient
– Provider
– Institution
– Geographic area
7
Patient-County linkage
Crime, poverty, poor
County
housing, limited health
services
Age, race, marital status, disease severity,
Individual
comorbid condition, physician visits .
Onukwugha E, Osteen P, Jayasekera J, Mullins CD, Mair CA, Hussain A. Racial disparities in urologist visits among 8
elderly men with prostate cancer: a cohort analysis of patient-related and county of residence-related factors.
Cancer. 2014 Nov 1;120(21):3385-92. doi: 10.1002/cncr.28894.
Patient-Hospital linkage
Bed size, location, hospital
Hospital
type, hospital quality
Age, race, marital status, disease severity,
Individual
comorbid condition, readmissions.
Onukwugha E, Shaya FT, Saunders E, Weir MR . Ethnic disparities, hospital quality, and discharges against medical9
advice among patients with cardiovascular disease. Ethn Dis. 2009 Spring;19(2):172-8.
Patient-Physician linkage
Age, gender, training,
Physician
practice setting, location
Age, race, marital status, disease severity,
Individual
comorbid condition, treatment.
Onukwugha E, Mullins CD, Hsu VD, Seal B, Hussain A. Effect of urologists and medical oncologists on treatment of
10
elderly men with Stage IV prostate cancer. Urology. 2011 May;77(5):1088-95. doi: 10.1016/j.urology.2010.11.059.
Closing points
• Healthcare utilization can differ by subgroup
• Multilevel and multidimensional influences
• Innovative data linkages
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