title: Patients' annual income adequacy, insurance premiums and out-of-pocket expenses related to heart failure care.
abstract: OBJECTIVE
  To (1) identify the amount patients spend for insurance premiums, co-payments, deductibles, and other out-of-pocket costs related to HF and chronic health care services and estimate their annual non-reimbursed and out-of-pocket costs; and (2) identify patients' concerns about nonreimbursed and out-of-pocket expenses.
  
  
  BACKGROUND
  HF is one of the most expensive illnesses for our society with multiple health services and financial burdens for families.
  
  
  METHODS
  Mixed methods with quantitative questionnaires and qualitative interviews.
  
  
  RESULTS
  Patients (N = 149) reported annual averages for non-reimbursed health services co-payments and out-of-pocket costs ranging from $3913 to $5829 depending on insurance coverage. Thirty one patients (21%) reported inadequate health coverage related to their non-reimbursed costs.
  
  
  CONCLUSIONS
  Non-reimbursed costs related to HF care are substantial and vary depending on their insurance, health services use, and out-of-pocket costs. Patient referral to social services to assist with expenses could provide some relief from the burden of high HF-related costs.
authors.affiliation: University of Kansas School of Nursing, School of Nursing Building, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160-7502, USA. Electronic address: Upiamjariyakul@kumc.edu.
authors.forename: Ubolrat
authors.initials: U
authors.lastname: Piamjariyakul
authors.affiliation: University of Kansas School of Nursing, School of Nursing Building, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160-7502, USA.
authors.forename: Donna Macan
authors.initials: DM
authors.lastname: Yadrich
authors.affiliation: University of Kansas Hospital, USA.
authors.forename: Christy
authors.initials: C
authors.lastname: Russell
authors.affiliation: University of Kansas Hospital, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Myer
authors.affiliation: University of Kansas Hospital, USA.
authors.forename: Chanawee
authors.initials: C
authors.lastname: Prinyarux
authors.affiliation: University of Kansas Hospital, USA; School of Medicine, University of Kansas, University of Kansas Hospital, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Vacek
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, USA.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.affiliation: University of Kansas School of Nursing, School of Nursing Building, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160-7502, USA; Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
mesh_terms: D000368:Aged; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D006333:Heart Failure / Q000191:economics*; D006801:Humans; D007182:Income; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Complex chronic conditions; Health care costs; Heart failure; Home care; Out-of-pocket costs