| With the dramatic increase in the cost of healthcare over the past several decades, many payers have shifted the burden to the insured by means of increased cost-sharing. Especially in today's economic climate, many families may face financial burden related to the cost of insurance and out-of-pocket healthcare costs. Families who experience excessive or risky financial burden may attempt to reduce said burden by modifying subsequent utilization patterns, which may in turn affect their health and thus future healthcare needs. Specifically, families who delay or forgo care may be more likely to utilize healthcare inappropriately, or may be more likely to develop symptoms or conditions which worsen and result in illness that is more expensive to treat. However, no validated measure of family-level financial burden exists for families with children, and as such, there have been no studies investigating the relationship between family financial burden, unmet need, and inappropriate healthcare utilization among families with children. In order to address this gap in the literature, a novel measure of family-level financial burden was developed so as to be predictive of unmet healthcare need (Aim 1). The novel measure of family financial burden was validated in a second sample and the effect of family financial burden on delayed or forgone healthcare was estimated (Aim 2). Family financial burden and delayed or forgone needed care were associated with increases in emergency room visits and inpatient admissions for ambulatory care sensitive conditions (Aim 3). Aim 1 utilized data from 12 years of the National Health Interview Survey; Aims 2 and 3 utilized eight complete panels of the Medical Expenditure Panel Survey, spanning nine years (2002-2010). This dissertation will open up new avenues of important research by developing and validating a novel measure of family financial burden, thereby providing a generalizable quantification of a modifiable aspect of the healthcare system, burdensome healthcare costs. Applying such a measure in future research will better allow researchers and policy-makers to understand how burdensome costs affect healthcare utilization and health outcomes within the context of the family. |
