title: A single question about a respondent's perceived financial ability to pay monthly bills explains more variance in health utility scores than absolute income and assets questions.
abstract: To evaluate a general question about ability to meet monthly bills as an alternative to direct questions about income and assets in health utility studies.
  
  
  
  We used data from the National Health Measurement Study-a US nationally representative telephone survey collected in 2005-2006. It included health utility measures (EuroQol-5D-3L, Health Utilities Index Mark 3, Short Form-6D, and Quality of Well-being Index) and household income, assets, and financial ability to meet monthly bills questions. Each utility score was regressed on: income and assets (Model 1); difficulty paying bills (DPB) (Model 2); income, assets, and DPB (Model 3). All models used survey weights and adjusted for demographics and education.
  
  
  
  Among 3666 respondents, as income and assets increased, DPB decreased. The DPB question had fewer missing values (n = 30) than income (n = 311) or assets (n = 373). Model 2 (DPB only) explained more variance in health utility than Model 1 (income and assets only). Including all measures (Model 3) had very modest improvement in R (2), e.g., values were 0.112 (Model 1), 0.166 (Model 2), and 0.175 (Model 3) for EuroQol-5D-3L.
  
  
  
  The single question on DPB yields more information and has less missing values than the traditionally used income and assets questions.
authors.affiliation: Department of General Internal Medicine, University of Pittsburgh Medical Center, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA. hanmerjz@upmc.edu.
authors.forename: Janel
authors.initials: J
authors.lastname: Hanmer
authors.affiliation: Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA.
authors.forename: Dasha
authors.initials: D
authors.lastname: Cherepanov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D003710:Demography; D005260:Female; D000067571:Financial Statements; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D044465:White People
keywords: Assets; Financial ability; Health utility; Health-related quality of life; Income; Socioeconomic status