title: Patient perceptions of asthma-related financial burden: public vs. private health insurance in the United States.
abstract: BACKGROUND
  Given the complexity of the health insurance market in the United States and the confusion that often stems from these complexities, patient perception about the value of health insurance in managing chronic disease is important to understand.
  
  
  OBJECTIVE
  To examine differences between public and private health insurance in perceptions of financial burden with managing asthma, outcomes, and factors that explain these perceptions.
  
  
  METHODS
  Secondary analysis was performed using baseline data from a randomized clinical trial that were collected through telephone interviews with 219 African American women seeking services for asthma and reporting perceptions of financial burden with asthma management. Path analysis with multigroup models and multiple variable regression analyses were used to examine associations.
  
  
  RESULTS
  For public (P < .001) and private (P < .01) coverage, being married and more educated were indirectly associated with greater perceptions of financial burden through different explanatory pathways. When adjusted for multiple morbidities, asthma control, income, and out-of-pocket expenses, those with private insurance used fewer inpatient (P < .05) and emergency department (P < .001) services compared with those with public insurance. When also adjusted for health insurance, greater financial burden was associated with more urgent office visits (P < .001) and lower quality of life (P < .001).
  
  
  CONCLUSIONS
  African American women who perceive asthma as a financial burden regardless of health insurance report more urgent health care visits and lower quality of life. Burden may be present despite having and being able to generate economic resources and health insurance. Further policy efforts are indicated and special attention should focus on type of coverage.
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan. Electronic address: minalrp@umich.edu.
authors.forename: Minal R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Cleopatra H
authors.initials: CH
authors.lastname: Caldwell
authors.affiliation: Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Peter X K
authors.initials: PX
authors.lastname: Song
authors.affiliation: Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: John R C
authors.initials: JR
authors.lastname: Wheeler
mesh_terms: D000328:Adult; D001741:Black or African American; D001249:Asthma / Q000188:drug therapy / Q000191:economics*; D017281:Cost of Illness; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D059033:For-Profit Insurance Plans / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D009310:National Health Insurance, United States / Q000191:economics*; D010465:Perception; D011788:Quality of Life; D014481:United States
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