Trends: Financial burden of health care, 2001-2004

Health Affairs

Volumn 27, Issue 1, 2008, Pages 188-195

  Banthin, Jessica S ^a   Cunningham, Peter ^b   Bernard, Didem M ^a  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

^b CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST CONTROL; COST EFFECTIVENESS ANALYSIS; FINANCIAL MANAGEMENT; HEALTH CARE; HEALTH CARE COST; HEALTH INSURANCE; HEALTH SERVICE; POPULATION; COST OF ILLNESS; DEMOGRAPHY; ECONOMICS; FAMILY; HUMAN; SOCIAL CLASS; STATISTICS; UNITED STATES;

COST OF ILLNESS; DEMOGRAPHY; FAMILY; FINANCING, PERSONAL; HEALTH EXPENDITURES; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; INSURANCE, HEALTH; SOCIAL CLASS; UNITED STATES;

EID: 38849115118     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.1.188     Document Type: Article

References (25)

1. Employee Benefit Research Institute, "2006 Health Confidence Survey: Dissatisfaction with Health Care System Doubles since 1998," EBRI Notes 27, no. 11, November 2006, http://www.ebri.org/pdf/notespdf/ EBRI_Notes_11-20061.pdf (accessed 29March 2007).
2. G. Claxton et al., "Health Benefits in 2006: Premium Increases Moderate, Enrollment in Consumer-Directed Health Plans Remains Modest," Health Affairs 25 (2006): w476-w485 (published online 26 September 2006; 10.1377/hlthaff.w5.476).
3. U.S. Census Bureau, "Historical Poverty Tables," 7 September 2007, http://www.census.gov/hhes/www/poverty/histpov/hstpov3.html (accessed 23 September 2007);
4. and P. Fronstin, "Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2006 Current Population Survey," Issue Brief no. 298 (Washington: EBRI, October 2006).
5. S.R. Collins et al., Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families, September 2006, http://www.cmwf.org/usr_doc/ Collins_squeezedrisinghltcarecosts_953.pdf (accessed 29 September 2006).
6. C. Hoffman et al., Medical Debt and Access to Health Care (Washington: Kaiser Commission on Medicaid and the Uninsured, September 2005);
7. and J.H. May and P.J. Cunningham, "Tough Tradeoffs: Medical Bills, Family Finances, and Access to Care," Issue Brief no. 85, June 2004, http://www.hschange.org/CONTENT/689 (accessed 29 September 2006).
8. J.S. Banthin and D.M. 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. Estimates of annual increases in health care costs were obtained from Centers for Medicare and Medicaid Services, "National Health Expenditure Data, Historical," 8 January 2007, http://www.cms.hhs.gov/ NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp (accessed 23 September 2007).
10. Estimates of annual increases in income were obtained from U.S. Census Bureau, 2007 Statistical Abstract, "Table 677: Money Income of Families - Median Income by Race and Hispanic Origin in Current and Constant (2004) Dollars: 1980 to 2004," http://www.census.gov/compendia/statab/ tables/07s0677.xls (accessed 29 March 2007). Both estimates of average annual increases do not account for general inflation.
11. To construct after-tax income, we simulated federal and state income taxes as well as Social Security and Medicare taxes on earnings using the Web-based version of TAXSIM 5.0. (National Bureau of Economic Research, Internet TAXSIM Version 5.0, at http://www.nber.org/∼taxsim). In addition, we imposed a $100 floor for after-tax family income to deal with underreporting and cases of legitimately low or negative incomes, which affects only 3.3 percent of observations.
12. J.S. Banthin and T.M. Selden. "The ABCs of Children's Health Care: How the Medicaid Expansions Affected Access, Burdens, and Coverage between 1987 and 1996," Inquiry 40, no. 2 (2003): 133-145;
13. T.M. Selden and J.S. Banthin, "Health Care Expenditure Burdens among Elderly Adults: 1987 and 1996," Medical Care 41, no. 7 Supp. (2003): III13-III23;
14. and D.M. Bernard, J.S. Banthin, and W.E. Encinosa, "Health Care Expenditure Burdens among Adults with Diabetes in 2001," Medical Care 44, no. 3 (2006): 210-215.
15. 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).
16. Estimates of financial burden using the 5 percent threshold for low-income people are available in an online appendix, at http://content. healthaffairs.org/cgi/content/full/27/1/188/DC1.
17. The 2004 estimate of 17.7 percent with high burdens is lower than the estimate for 2003 (19.2 percent) reported in an earlier study using MEPS: Banthin and Bernard, "Changes in Financial Burdens for Health Care." Although the change between 2003 and 2004 is statistically significant and represents a decrease in the percentage with burdens, it is likely the result of year-to-year fluctuations in the data rather than the start of a new trend. Regardless, the conclusions of this study do not change when comparing 2001 with 2003 or 2004, which shows burden levels increasing during a period of rapidly rising health care costs and stagnant incomes.
18. In Exhibits 2 and 3, employment-related and nongroup coverage is combined because sample sizes for nongroup coverage among poor, low-income, and middle-income people are too small for reliable estimates. Trends for group coverage by income tend to be similar to overall private insurance coverage.
19. We computed the average percentage paid out of pocket among people with an expense. Thus, the 20 percent paid by one personwas averaged with the 40 percent paid by another, regardless of the size of the total payment.
20. G. Claxton et al., "Health Benefits in 2007: Premium Increases Fall to an Eight-Year Low, while Offer Rates and Enrollment Remain Stable," Health Affairs 26, no. 5 (2007): 1407-1416.
21. J.A. Poisal et al., "Health Spending Projections through 2016:Modest Changes Obscure Part D's Impact," Health Affairs 26, no. 2 (2007): w242-w253 (published online 21 February 2007; 10.1377/hlthaff.26.2.w242).
22. Hoffman et al., Medical Debt and Access to Health Care;
23. and May and Cunningham, Tough Tradeoffs.
24. R. Kronick and T. Gilmer, "Explaining the Decline in Health Insurance Coverage, 1979-1995," Health Affairs 18, no. 2 (1999): 30-47.
25. J. Alker, Premium Assistance Programs: How Are They Financed and Do States Save Money? (Washington: Kaiser Commission, October 2005).