title: Financial burdens and barriers to care among nonelderly adults: The role of functional limitations and chronic conditions.
abstract: BACKGROUND
  People with functional limitations and chronic conditions account for the greatest resource use within the health care system.
  
  
  OBJECTIVE
  To examine financial burdens and barriers to care among nonelderly adults, focusing on the role of functional limitations and chronic conditions.
  
  
  METHODS
  High financial burden is defined as medical spending exceeding 20 percent of family income. Financial barriers are defined as delaying care/being unable to get care for financial reasons, and reporting that delaying care/going without was a big problem. Data are from the Medical Expenditure Panel Survey (2008-2012).
  
  
  RESULTS
  Functional limitations are associated with increased prevalence of financial burdens. Among single adults, the frequency of high burdens is 20.3% for those with functional limitations, versus 7.8% for those without. Among those with functional limitations, those with 3 or more chronic conditions are twice as likely to have high burdens compared to those without chronic conditions (22.2% versus 11.1%, respectively). Similar patterns occur among persons in multi-person families whose members have functional limitations and chronic conditions. Having functional limitations and chronic conditions is also strongly associated with financial barriers to care: 40.2% among the uninsured, 21.9% among those with public coverage, and 13.6% among those with private group insurance were unable to get care.
  
  
  CONCLUSIONS
  Functional limitations and chronic conditions are associated with increased prevalence of burdens and financial barriers in all insurance categories, with the exception that an association between functional limitations and the prevalence of burdens was not observed for public coverage.
authors.affiliation: Agency for Healthcare Research and Quality (AHRQ), USA. Electronic address: Didem.Bernard@ahrq.hhs.gov.
authors.forename: Didem
authors.initials: D
authors.lastname: Bernard
authors.affiliation: Agency for Healthcare Research and Quality (AHRQ), USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Selden
authors.affiliation: Johns Hopkins School of Public Health, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Yeh
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D002908:Chronic Disease / Q000191:economics*; D015897:Comorbidity; D017281:Cost of Illness; D006233:Persons with Disabilities; D005190:Family; D005102:Health Expenditures; D006296:Health Services / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income; D019458:Insurance Coverage; D007348:Insurance, Health; D017057:Medically Uninsured
keywords: Chronic conditions; Financial barriers to care; Financial burdens; Functional limitations