title: Nonmedical Out-of-Pocket Patient and Companion Expenditures Associated With Glaucoma Care.
abstract: OBJECTIVE
  Nonmedical out-of-pocket cost to both patients and their companions of office visits for routine glaucoma care has not been extensively studied in the United States. We evaluate potential key predictors of patient expenditures that are critical to assessing the cost-effectiveness of glaucoma health care delivery.
  
  
  METHODS
  In total, 300 patients responded to the survey in 3 clinics in 2 clinical practice settings. Main outcome measures included both average visit and yearly expenditures.
  
  
  RESULTS
  Of the 300 patients, the majority were female (n=187, 62.3%) and African American (n=171, 57.0%). The median age was 66 years. The median [range; mean (SD)] expenditure per patient visit was $22.10 ($11.1, $42.9; $44.1 (72.8)). Patients with companions paid $38.77 more in average visit expenditure (β: 0.87, P<0.001). The average visit expenditure for retired patients was $17.37 less when compared with nonretired patients (β: -0.4, P=0.004). Patients living in a rural or suburban area paid $43.91 and $14.13 more per visit, respectively (β: 0.73, P=0.0004; β: 0.31, P=0.03), compared with patients living in an urban area. Patients with noncommercial insurance paid $24.01 less in average visit expenditure (β: -0.66, P=0.0008). The median yearly patient expenditure was $96.70 [$44.6, $222.7; $210.4 (333.9)]. Patients with companions paid $192.37 more in yearly expenditure (β: 0.9, P<0.001) than those without companions, whereas retired patients paid $80.83 less in yearly expenditure (β: -0.39, P=0.03) than nonretirees. Patients with noncommercial insurance paid $109.34 less in yearly expenditure (β: -0.63, P=0.01).
  
  
  CONCLUSIONS
  Although a small part of the total cost of glaucoma care, nonmedical out-of-pocket costs constitute a substantial noncovered medical expense to most patients in the United States. Patients who are employed, come with companions, live in nonurban areas, or are on Medicare have greater expenditures.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine‡Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD†Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Schehlein
authors.forename: Lily T
authors.initials: LT
authors.lastname: Im
authors.forename: Alan L
authors.initials: AL
authors.lastname: Robin
authors.forename: Eberechukwu
authors.initials: E
authors.lastname: Onukwugha
authors.forename: Osamah J
authors.initials: OJ
authors.lastname: Saeedi
mesh_terms: D000368:Aged; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D033062:Friends; D005901:Glaucoma / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data