{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T20:17:19Z","timestamp":1740169039433,"version":"3.37.3"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Health Inf Sci Syst"],"published-print":{"date-parts":[[2021,12]]},"DOI":"10.1007\/s13755-021-00153-9","type":"journal-article","created":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T20:05:04Z","timestamp":1623096304000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Who determines United States Healthcare out-of-pocket costs? Factor ranking and selection using ensemble learning"],"prefix":"10.1007","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9500-405X","authenticated-orcid":false,"given":"Chengcheng","family":"Zhang","sequence":"first","affiliation":[]},{"given":"Yujia","family":"Ding","sequence":"additional","affiliation":[]},{"given":"Qidi","family":"Peng","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"key":"153_CR1","unstructured":"Out-of-pocket spending. Peterson-KFF Health System Tracker. 2017. https:\/\/www.healthsystemtracker.org\/indicator\/access-affordability\/out-of-pocket-spending\/."},{"issue":"16","key":"153_CR2","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1056\/NEJMp1306826","volume":"369","author":"PA Ubel","year":"2013","unstructured":"Ubel PA, Abernethy AP, Yousuf\u00a0Zafar S. Full disclosure\u2013out-of-pocket costs as side effects. New Engl J Med. 2013;369(16):1484. https:\/\/doi.org\/10.1056\/NEJMp1306826.","journal-title":"New Engl J Med"},{"issue":"11","key":"153_CR3","first-page":"801","volume":"15","author":"EA Finkelstein","year":"2009","unstructured":"Finkelstein EA, Tangka FK, Trogdon JG, Sabatino SA, Richardson LC. Cancer treatment cost in the United States: has the burden shifted over time? Am J Manag C. 2009;15(11):801.","journal-title":"Am J Manag C"},{"issue":"4","key":"153_CR4","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1111\/1475-6773.12444","volume":"51","author":"K Baird","year":"2016","unstructured":"Baird K. High out-of-pocket medical spending. among the poor and elderly in nine developed countries. Health Serv Res. 2016;51(4):1467. https:\/\/doi.org\/10.1111\/1475-6773.12444.","journal-title":"Health Serv Res"},{"key":"153_CR5","unstructured":"Gwet P, Machlin SR. Out-of-pocket health care Expenses for non-elderly families by income and family structure, 2015. In: Statistical Brief (Medical Expenditure Panel Survey (US)). 2018"},{"issue":"5","key":"153_CR6","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1016\/j.sapharm.2017.06.005","volume":"14","author":"NH Kim","year":"2018","unstructured":"Kim NH, Look KA. Effects of the Affordable Care Act\u2019s contraceptive coverage requirement on the utilization and out-of-pocket costs of prescribed oral contraceptives. Res Social Adm Pharm. 2018;14(5):479. https:\/\/doi.org\/10.1016\/j.sapharm.2017.06.005.","journal-title":"Res Social Adm Pharm"},{"issue":"2","key":"153_CR7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/jphs.12170","volume":"8","author":"HA Kang","year":"2017","unstructured":"Kang HA, Barner JC. The relationship between out-of-pocket healthcare expenditures and insurance status among individuals with chronic obstructive pulmonary disease. J Pharm Health Serv Res. 2017;8(2):107. https:\/\/doi.org\/10.1111\/jphs.12170.","journal-title":"J Pharm Health Serv Res"},{"key":"153_CR8","unstructured":"Soni A. Out-of-pocket expenditures for adults with health care expenses for multiple chronic conditions, U.S. Civilian Noninstitutionalized Population, 2014. Statistical Brief (Medical Expenditure Panel Survey (US)). 2017. https:\/\/meps.ahrq.gov\/data_files\/publications\/st498\/stat498.shtml."},{"issue":"6","key":"153_CR9","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1377\/hlthaff.20.6.267","volume":"20","author":"W Hwang","year":"2001","unstructured":"Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Affairs. 2001;20(6):267. https:\/\/doi.org\/10.1377\/hlthaff.20.6.267.","journal-title":"Health Affairs"},{"issue":"1","key":"153_CR10","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1377\/hlthaff.28.1.15","volume":"28","author":"KA Paez","year":"2009","unstructured":"Paez KA, Zhao L, Hwang W. Rising out-of-pocket spending for chronic conditions: a ten-year trend. Health Affairs. 2009;28(1):15. https:\/\/doi.org\/10.1377\/hlthaff.28.1.15.","journal-title":"Health Affairs"},{"issue":"18","key":"153_CR11","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1001\/jama.1996.03540180029029","volume":"276","author":"C Hoffman","year":"1996","unstructured":"Hoffman C, Rice D, Sung HY. Persons with chronic conditions. Their prevalence and costs. JAMA. 1996;276(18):1473. https:\/\/doi.org\/10.1001\/jama.1996.03540180029029.","journal-title":"JAMA"},{"issue":"11","key":"153_CR12","first-page":"925","volume":"20","author":"E Carrier","year":"2014","unstructured":"Carrier E, Cunningham P. Medical cost burdens among nonelderly adults with asthma. Am J Manag C. 2014;20(11):925.","journal-title":"Am J Manag C"},{"issue":"3","key":"153_CR13","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.diabres.2009.11.021","volume":"87","author":"HW Rodbard","year":"2010","unstructured":"Rodbard HW, Green AJ, Fox KM, S.\u00a0Grandy for\u00a0the SHIELD Study\u00a0Group. Impact of type 2 diabetes mellitus on prescription medication burden and out-of-pocket healthcare expenses. Diabetes Res Clin Pr. 2010;87(3):360. https:\/\/doi.org\/10.1016\/j.diabres.2009.11.021.","journal-title":"Diabetes Res Clin Pr"},{"key":"153_CR14","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1613\/jair.614","volume":"11","author":"D Opitz","year":"1999","unstructured":"Opitz D, Maclin R. Popular ensemble methods: an empirical study. J Artif Intell Res. 1999;11:169. https:\/\/doi.org\/10.1613\/jair.614.","journal-title":"J Artif Intell Res"},{"key":"153_CR15","volume-title":"The elements of statistical learning","author":"J Friedman","year":"2001","unstructured":"Friedman J, Hastie T, Tibshirani R. The elements of statistical learning, vol. 1. New York: Springer; 2001."},{"key":"153_CR16","doi-asserted-by":"publisher","unstructured":"Ho TK. Random decision forests. In: Proceedings of 3rd international conference on document analysis and recognition. 1995;1:278. https:\/\/doi.org\/10.1109\/ICDAR.1995.598994","DOI":"10.1109\/ICDAR.1995.598994"},{"issue":"7","key":"153_CR17","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.1097\/mlr.0b013e3181a23e3a","volume":"47","author":"JW Cohen","year":"2009","unstructured":"Cohen JW, Cohen SB, Banthin JS. The medical expenditure panel survey: a national information resource to support healthcare cost research and inform policy and practice. Med Care. 2009;47(7):S44. https:\/\/doi.org\/10.1097\/mlr.0b013e3181a23e3a.","journal-title":"Med Care"},{"issue":"7 Suppl 1","key":"153_CR18","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.1097\/MLR.0b013e3181a23e3a","volume":"47","author":"JW Cohen","year":"2009","unstructured":"Cohen JW, Cohen SB, Banthin JS, The medical expenditure panel survey: a national information resource to support healthcare cost research and inform policy and practice. Medical care. 2009;47(7 Suppl 1):S44. https:\/\/doi.org\/10.1097\/MLR.0b013e3181a23e3a","journal-title":"Medical care"},{"issue":"1","key":"153_CR19","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1377\/hlthaff.2010.0216","volume":"30","author":"J Cylus","year":"2010","unstructured":"Cylus J, Hartman M, Washington B, Andrews K, Catlin A. Pronounced gender and age differences are evident in personal health care spending per person. Health Affairs. 2010;30(1):153. https:\/\/doi.org\/10.1377\/hlthaff.2010.0216.","journal-title":"Health Affairs"},{"issue":"5p1","key":"153_CR20","doi-asserted-by":"publisher","first-page":"1603","DOI":"10.1111\/j.1475-6773.2009.01004.x","volume":"44","author":"BL Cook","year":"2009","unstructured":"Cook BL, Manning WG. Measuring racial\/ethnic disparities across the distribution of health care expenditures. Health Serv Res. 2009;44(5p1):1603.","journal-title":"Health Serv Res"},{"issue":"4","key":"153_CR21","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1177\/1077558708330425","volume":"66","author":"PK Derose","year":"2009","unstructured":"Derose PK, Bahney BW, Lurie N, Escarce JJ. Review: immigrants and health care access, quality, and cost. Med Care Res Rev. 2009;66(4):355. https:\/\/doi.org\/10.1177\/1077558708330425.","journal-title":"Med Care Res Rev"},{"key":"153_CR22","unstructured":"Liu S, Chollet D. Price and income elasticity of the demand for health insurance and health care services: a critical review of the literature. Mathematica Policy Research. 2006."},{"issue":"2","key":"153_CR23","doi-asserted-by":"publisher","first-page":"319","DOI":"10.2337\/dc11-1770","volume":"35","author":"CM Smith-Spangler","year":"2012","unstructured":"Smith-Spangler CM, Bhattacharya J, Goldhaber-Fiebert JD. Diabetes, its treatment, and catastrophic medical spending in 35 developing countries. Diabetes Care. 2012;35(2):319. https:\/\/doi.org\/10.2337\/dc11-1770.","journal-title":"Diabetes Care"},{"issue":"4","key":"153_CR24","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1093\/jeea\/jvy017","volume":"16","author":"L Einav","year":"2018","unstructured":"Einav L, Finkelstein A. Moral hazard in health insurance: what we know and how we know it. J Euro Econ Assoc. 2018;16(4):957. https:\/\/doi.org\/10.1093\/jeea\/jvy017.","journal-title":"J Euro Econ Assoc"},{"key":"153_CR25","unstructured":"Ashman JJ, Rui P, Okeyode T. Characteristics of office-based physician visits, 2016. NCHS Data Brief (CDC Stacks). 2019. https:\/\/stacks.cdc.gov\/view\/cdc\/62369."},{"key":"153_CR26","doi-asserted-by":"publisher","first-page":"107043","DOI":"10.1016\/j.csda.2020.107043","volume":"152","author":"M Baak","year":"2020","unstructured":"Baak M, Koopman R, Snoek HL, Klous S. A new correlation coefficient between categorical, ordinal and interval variables with Pearson characteristics. Comput Stat Data Anal. 2020;152:107043. https:\/\/doi.org\/10.1016\/j.csda.2020.107043.","journal-title":"Comput Stat Data Anal"},{"issue":"1","key":"153_CR27","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1589\/jpts.30.174","volume":"30","author":"M Huh","year":"2018","unstructured":"Huh M. The relationships between cognitive function and hearing loss among the elderly. J Phys Ther Sci. 2018;30(1):174. https:\/\/doi.org\/10.1589\/jpts.30.174.","journal-title":"J Phys Ther Sci"},{"issue":"8","key":"153_CR28","first-page":"1037","volume":"157","author":"R H\u00e9bert","year":"1997","unstructured":"H\u00e9bert R. Functional decline in old age. CMAJ. 1997;157(8):1037.","journal-title":"CMAJ"},{"issue":"4","key":"153_CR29","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1111\/j.1751-7176.2011.00434.x","volume":"13","author":"AN Long","year":"2011","unstructured":"Long AN, Dagogo-Jack S. Comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens. 2011;13(4):244. https:\/\/doi.org\/10.1111\/j.1751-7176.2011.00434.x.","journal-title":"J Clin Hypertens"},{"issue":"1","key":"153_CR30","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1146\/annurev.publhealth.22.1.355","volume":"22","author":"TL Visscher","year":"2001","unstructured":"Visscher TL, Seidell JC. The public health impact of obesity. Annu Rev Publ Health. 2001;22(1):355. https:\/\/doi.org\/10.1146\/annurev.publhealth.22.1.355.","journal-title":"Annu Rev Publ Health"},{"key":"153_CR31","volume-title":"Generalized additive models","author":"TJ Hastie","year":"1990","unstructured":"Hastie TJ, Tibshirani RJ. Generalized additive models, vol. 43. New York: CRC Press; 1990."},{"key":"153_CR32","unstructured":"Kominski GF, Rasmussen PW, Zhang C, Hassan S, Freund D. Ten years of the Affordable Care Act: Major gains and ongoing disparities. UCLA Center for Health Policy Research. 2020. http:\/\/healthpolicy.ucla.edu\/publications\/search\/pages\/detail.aspx?PubID=1930."},{"key":"153_CR33","volume-title":"Estimating the cost of racial and ethnic health disparities","author":"T Waidmann","year":"2009","unstructured":"Waidmann T. Estimating the cost of racial and ethnic health disparities. Washington, DC: Urban Institute; 2009."},{"issue":"8","key":"153_CR34","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.2105\/AJPH.2004.041418","volume":"95","author":"EA Jacobs","year":"2005","unstructured":"Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95(8):1410.","journal-title":"Am J Public Health"},{"issue":"7","key":"153_CR35","doi-asserted-by":"publisher","first-page":"885","DOI":"10.2105\/AJPH.81.7.885","volume":"81","author":"LC Harlan","year":"1991","unstructured":"Harlan LC, Bernstein AB, Kessler LG. Cervical cancer screening: who is not screened and why? Am J Public Health. 1991;81(7):885. https:\/\/doi.org\/10.2105\/AJPH.81.7.885.","journal-title":"Am J Public Health"},{"issue":"4","key":"153_CR36","first-page":"490","volume":"144","author":"DJ Hu","year":"1986","unstructured":"Hu DJ, Covell RM. Health care usage by Hispanic outpatients as function of primary language. Western J Med. 1986;144(4):490.","journal-title":"Western J Med"},{"issue":"Suppl 2","key":"153_CR37","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s11606-007-0346-6","volume":"22","author":"EM Cheng","year":"2007","unstructured":"Cheng EM, Chen A, Cunningham W. Primary language and receipt of recommended health care among Hispanics in the United States. J Gen Intern Med. 2007;22(Suppl 2):283.","journal-title":"J Gen Intern Med"},{"key":"153_CR38","unstructured":"Planned knee and hip replacement surgeries are on the rise in the us. Blue Cross Blue Shield, Chicago. 2019. https:\/\/www.bcbs.com\/the-health-of-america\/reports\/planned-knee-and-hip-replacement-surgeries-are-the-rise-the-us."},{"key":"153_CR39","doi-asserted-by":"crossref","unstructured":"Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children; United States, 2007. National Health Statistics Report (CDC). 2008. https:\/\/stacks.cdc.gov\/view\/cdc\/5266.","DOI":"10.1037\/e623942009-001"},{"issue":"11","key":"153_CR40","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1016\/j.jpain.2015.07.013","volume":"16","author":"RL Nahin","year":"2015","unstructured":"Nahin RL, Stussman BJ, Herman PM. Out-of-pocket expenditures on complementary health approaches associated with painful health conditions in a nationally representative adult sample. J Pain. 2015;16(11):1147. https:\/\/doi.org\/10.1016\/j.jpain.2015.07.013.","journal-title":"J Pain"},{"issue":"8","key":"153_CR41","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s40273-015-0268-9","volume":"33","author":"T Seuring","year":"2015","unstructured":"Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics. 2015;33(8):811. https:\/\/doi.org\/10.1007\/s40273-015-0268-9.","journal-title":"Pharmacoeconomics"},{"issue":"12","key":"153_CR42","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1001\/jama.2012.340","volume":"307","author":"P Karaca-Mandic","year":"2012","unstructured":"Karaca-Mandic P, Jena AB, Joyce GF, Goldman DP. Out-of-pocket medication costs and use of medications and health care services among children with asthma. JAMA. 2012;307(12):1284. https:\/\/doi.org\/10.1001\/jama.2012.340.","journal-title":"JAMA"},{"issue":"14","key":"153_CR43","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.1016\/j.patrec.2010.03.014","volume":"31","author":"R Genuer","year":"2010","unstructured":"Genuer R, Poggi JM, Tuleau-Malot C. Variable selection using random forests. Pattern Recog Lett. 2010;31(14):2225. https:\/\/doi.org\/10.1016\/j.patrec.2010.03.014.","journal-title":"Pattern Recog Lett"},{"issue":"1","key":"153_CR44","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","volume":"58","author":"R Tibshirani","year":"1996","unstructured":"Tibshirani R. Regression shrinkage and selection via the lasso. J R Stat Soc: Series B (Methodological). 1996;58(1):267. https:\/\/doi.org\/10.1111\/j.2517-6161.1996.tb02080.x.","journal-title":"J R Stat Soc: Series B (Methodological)"},{"key":"153_CR45","unstructured":"Breiman L. Manual on setting up, using, and understanding random forests v3. 1. Statistics Department University of California Berkeley. CA, USA. 2002;1:58.\u00a0"},{"issue":"10","key":"153_CR46","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1097\/MLR.0b013e318185cdf2","volume":"46","author":"H Yu","year":"2008","unstructured":"Yu H, Dick AW, Szilagyi PG. Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs? Med Care. 2008;46(10):1064. https:\/\/doi.org\/10.1097\/MLR.0b013e318185cdf2.","journal-title":"Med Care"},{"issue":"1","key":"153_CR47","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1162\/REST_a_00232","volume":"95","author":"C Shen","year":"2013","unstructured":"Shen C. Determinants of health care decisions: insurance, utilization, and expenditures. Rev Econ Stat. 2013;95(1):142. https:\/\/doi.org\/10.1162\/REST_a_00232.","journal-title":"Rev Econ Stat"}],"container-title":["Health Information Science and Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13755-021-00153-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13755-021-00153-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13755-021-00153-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T14:23:50Z","timestamp":1638541430000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13755-021-00153-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,7]]},"references-count":47,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["153"],"URL":"https:\/\/doi.org\/10.1007\/s13755-021-00153-9","relation":{},"ISSN":["2047-2501"],"issn-type":[{"type":"electronic","value":"2047-2501"}],"subject":[],"published":{"date-parts":[[2021,6,7]]},"assertion":[{"value":"17 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"22"}}