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01-09-2016 | Brief Communication | Uitgave 9/2016

Quality of Life Research 9/2016

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

Quality of Life Research > Uitgave 9/2016
Janel Hanmer, Dasha Cherepanov
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Electronic supplementary material

The online version of this article (doi:10.​1007/​s11136-016-1269-7) contains supplementary material, which is available to authorized users.



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.

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