title: Out-of-pocket expenses and their burden in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To describe and understand the burden of out-of-pocket expenses in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  We studied out-of-pocket expenses and their burden in 8,545 US patients with RA. We determined direct medical costs, out-of-pocket expenses, the burden of out-of-pocket expenses, household income, and measures of RA severity and outcome. In addition, patients were classified into 3 groups based on the level of burden caused by out-of-pocket expenses: no or limited problem (I am able to pay the bills without much problem); moderate problem (paying the bills takes away some money I need for other activities); and a great problem (I can't purchase all of the medications or medical care that I need).
  
  
  RESULTS
  A total of 43.6% of patients reported problems paying medical bills after insurance payments and 9.0% reported severe or great problems. Problems with expenses were associated with measures of RA severity, but also and particularly with lower household income and absence of health insurance. The proportion of household income that was consumed by out-of-pocket spending for the 3 groups was 2.4%, 7.2%, and 19.2%, respectively, and the percentage of patients meeting the 185% poverty level for these groups was 12.3%, 24.4%, and 51.3%, respectively.
  
  
  CONCLUSIONS
  The out-of-pocket burden is substantial, particularly in those <65 years of age. Out-of-pocket expenses exert their severity predominantly on those with the most severe RA who have the least ability to pay. Household income is the primary determinant of out-of-pocket burden, followed by RA severity, and type of health insurance.
authors.affiliation: University of Kansas School of Medicine, Kansas, USA. fwolfe@arthritis-research.org
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
authors.forename: Kaleb
authors.initials: K
authors.lastname: Michaud
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics; D001172:Arthritis, Rheumatoid / Q000191:economics* / Q000453:epidemiology*; D015897:Comorbidity; D017281:Cost of Illness; D016527:Drug Costs; D005260:Female; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty / Q000706:statistics & numerical data; D012044:Regression Analysis; D020379:Risk Adjustment / Q000191:economics / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents