Trends: How much 'skin in the game' do medicare beneficiaries have? The increasing financial burden of health care spending, 1997-2003

Health Affairs

Volumn 26, Issue 6, 2007, Pages 1692-1701

  Neuman, Patricia ^a   Cubanski, Juliette ^a   Desmond, Katherine A ^b   Rice, Thomas H ^c  

^a HENRY J KAISER FAMILY FOUNDATION   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; COST OF ILLNESS; ECONOMICS; FEE; FEMALE; FINANCIAL MANAGEMENT; HEALTH CARE COST; HUMAN; MALE; MEDICARE; SOCIOECONOMICS; STATISTICAL MODEL; STATISTICS; UNITED STATES;

AGED; AGED, 80 AND OVER; COST OF ILLNESS; FEMALE; FINANCING, PERSONAL; HEALTH EXPENDITURES; HUMANS; LOGISTIC MODELS; MALE; MEDICARE; PRESCRIPTION FEES; SOCIOECONOMIC FACTORS; UNITED STATES;

EID: 36849069855     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.6.1692     Document Type: Article

References (28)

1. G. Claxton et al., Employer Health Benefits: 2006 Annual Survey, September 2006, http://www.kff.org/insurance/7527/upload/7527.pdf (accessed 12 October 2006).
2. Authors' calculations based on data from National Center for Health Statistics, Health, United States, 2005, Table 139, "Medicare Enrollees and Expenditures and Percent Distribution, According to Type of Service: United States and Other Areas, Selected Years 1970-2004," http://www.cdc.gov/nchs/data/hus/hus05.pdf#summary (accessed 21 August 2006);
3. U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplements, "Historical Income Tables - People," http://www.census.gov/hhes/www/income/histinc/p10ar.html (accessed 21 August 2006);
4. and Social Security Cost-of-Living Adjustments, http://www.ssa.gov/OACT/ COLA/colaseries.html (accessed 13 August 2006).
5. See, for example, K. Davis et al., "Medicare versus Private Insurance: Rhetoric and Reality," Health Affairs 21 (2002):w311-w324 (published online 9 October 2002; 10.1377/hlthaff.w2.311);
6. and M. Merlis, D. Gould, and B.Mahato, "Rising Out-of-Pocket Spending for Medical Care; A Growing Strain on Family Budgets," February 2006, http://www.commonwealthfund.org/usr_doc/Merlis_risingoopspending_887.pdf (accessed 10 July 2007).
7. Kaiser Family Foundation and Hewitt Associates, Retiree Health Benefits Examined: Findings from the Kaiser/Hewitt 2006 Survey on Retiree Health Benefits, December 2006, http://www.kff.org/medicare/upload/7587.pdf (accessed 12 July 2007).
8. J. Banthin and D. Bernard, "Changes in Financial Burdens for Health Care: National Estimates for the Population Younger than Sixty-five Years, 1996 to 2003," Journal of the American Medical Association 296, no. 22 (2006): 2712-2719.
9. Data beyond 2003 were not available when this analysis was conducted.
10. The MCBS surveys residents in a variety of institutional settings including licensed nursing homes, retirement homes, mental health/mental retardation facilities, continuing care facilities, assisted living facilities, and rehabilitation facilities.
11. See M. Moon, Medicare: A Policy Primer (Washington: Urban Institute Press, 2006);
12. S. Crystal et al., "Out-of-Pocket Health Care Costs among Older Americans," Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 55, no. 1 (2000): S51-S62;
13. D. Gross et al., "Out-of-Pocket Health Spending by Poor and Near-Poor Elderly Medicare Beneficiaries," Health Services Research 34, no. 1, Part 2 (1999): 241-254;
14. and C. Caplan and N. Brangan, "Out-of-Pocket Spending on Health Care by Medicare Beneficiaries Age Sixty-five and Older in 2003," Data Digest, September 2004, http://assets.aarp.org/rgcenter/health/dd101_spending.pdf (accessed 12 October 2006).
15. This suggests that our results could underestimate the actual spending burden for beneficiaries who pay and file income taxes.
16. Other researchers have used a similar approach, including Moon, Medicare: A Policy Primer;
17. Caplan and Brangan, "Out-of-Pocket Spending";
18. and Crystal et al., "Out-of-Pocket Health Care Costs." We discuss implications of this approach in a technical appendix, available online at http://content.healthaffairs.org/cgi/content/full/26/6/1692/DC1.
19. The technical appendix contains a complete discussion of methods used to compute out-of-pocket spending burden and their relative merits; ibid.
20. See, for example, Merlis et al, "Rising Out-of-Pocket Spending for Medical Care"; and C. Schoen et al., "Insured but Not Protected: How Many Adults Are Underinsured?" Health Affairs 24 (2005): w289-w302 (published online 14 June 2005; 10.1377/hlthaff.w5.289).
21. The MCBS provides replicate weights that can be used with this method, where multiple subsamples are chosen from the full sample, and the variability among subsample estimates is used to estimate variance for the full sample. See J.M. Gossett et al., "How Complex Can Complex Survey Analysis Be with SAS?" in SAS Institute Inc., "Proceedings of the Twenty-seventh Annual SAS Users Group International Conference, 2002," http://www2.sas.com/ proceedings/sugi27/p266-27.pdf (accessed 8 October 2006);
22. and J.M. Brick, D. Morganstein, and R. Valliant, "Analysis of Complex Sample Data Using Replication," 29 July 2000, http://www.westat. com/wesvar/techpapers/ACS-Replication.pdf (accessed 8 October 2006).
23. The mean ratio (37.4 percent) is larger than the median (15.5 percent) and ratio of sums (20.6 percent).
24. M. Lillie-Blanton and C. Hoffman, "The Role of Health Insurance Coverage in Reducing Racial/Ethnic Disparities in Health Care," Health Affairs 24, no. 2 (2005): 398-408.
25. Authors' analysis of data from 2003 MCBS Cost and Use file.
26. Kaiser Family Foundation, "Dual Eligibles: Medicaid's Role for Low Income Beneficiaries," Fact Sheet, February 2006, http://www.kff.org/ medicaid/4091.cfm (accessed 30 July 2007).
27. The corresponding increases in mean values for out-of-pocket spending and income from 1997 to 2003 are, respectively, 42 percent (from$2,648 to $3,765) and 3 percent (from $17,756 to $18,254).
28. See, for example, M. Gold and L. Achman, "Average Out-of-Pocket Health Care Costs for Medicare+Choice Enrollees Increase Ten Percent in 2003," August 2003, http://www.commonwealthfund.org/usr_doc/ gold_averageoop2003_667.pdf (accessed 10 July 2007).