Development of a novel, objective measure of health care-related financial burden for U.S. families with children

Lauren E. Wisk, Ronald Gangnon, David J. Vanness, Alison A. Galbraith, John Mullahy, Whitney P. Witt

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective To develop and validate a theoretically based and empirically driven objective measure of financial burden for U.S. families with children. Data Sources The measure was developed using 149,021 families with children from the National Health Interview Survey, and it was validated using 18,488 families with children from the Medical Expenditure Panel Survey. Study Design We estimated the marginal probability of unmet health care need due to cost using a bivariate tensor product spline for family income and out-of-pocket health care costs (OOPC; e.g., deductibles, copayments), while adjusting for confounders. Recursive partitioning was performed on these probabilities, as a function of income and OOPC, to establish thresholds demarcating levels of predicted risk. Principal Findings We successfully generated a novel measure of financial burden with four categories that were associated with unmet need (vs. low burden: midlow OR: 1.93, 95 percent CI: 1.78-2.09; midhigh OR: 2.78, 95 percent CI: 2.49-3.10; high OR: 4.38, 95 percent CI: 3.99-4.80). The novel burden measure demonstrated significantly better model fit and less underestimation of financial burden compared to an existing measure (OOPC/income ≥10 percent). Conclusion The newly developed measure of financial burden establishes thresholds based on different combinations of family income and OOPC that can be applied in future studies of health care utilization and expenditures and in policy development and evaluation.

Original languageEnglish (US)
Pages (from-to)1852-1874
Number of pages23
JournalHealth Services Research
Issue number6
StatePublished - Dec 1 2014

All Science Journal Classification (ASJC) codes

  • Health Policy


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