The growing financial burden of health care: National and state trends, 2001-2006

Health Affairs

Volumn 29, Issue 5, 2010, Pages 1037-1044

  Cunningham, Peter J ^a  

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

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; FINANCIAL MANAGEMENT; HEALTH CARE; HEALTH CARE COST; HEALTH CARE QUALITY; HEALTH MAINTENANCE ORGANIZATION; HEALTH SERVICE; INCOME; PRIVATE HEALTH INSURANCE; SOCIOECONOMICS; TREND STUDY;

COST OF ILLNESS; FINANCING, PERSONAL; FOR-PROFIT INSURANCE PLANS; HEALTH CARE COSTS; HEALTH EXPENDITURES; HUMANS; INCOME; INSURANCE COVERAGE; STATE HEALTH PLANS; UNITED STATES;

EID: 77958061051     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2009.0493     Document Type: Article

References (21)

1. Banthin JS, Cunningham P, Bernard D. Financial burden of health care, 2001-2004. Health Aff (Millwood). 2008;27(1):188-95.
2. Schoen C, Collins SR, Kriss JL, Doty MM. How many are underinsured? Trends among U.S. adults, 2003 and 2007. Health Aff (Millwood). 2008;27(4):w298-309.
3. Cunningham P. Trade-offs getting tougher: problems paying medical bills increase for U.S. families, 2003-2007. Washington (DC): Center for Studying Health System Change; 2008 Sep. Tracking Report no. 21.
4. The MEPS sample design and estimation procedures include a number of features to enhance the capability for state estimates. The National Health Interview Survey - which is the sampling frame for MEPS - includes state as a stratification variable for first-stage sampling (that is, the selection of primary sampling units, or PSUs). All of the twenty-nine states used for state-level estimates have multiple PSUs. Almost all have a minimum of four PSUs, including "certainty" PSUs (large urban areas) that together cover about 60 percent of the state population. In addition, weights used to produce state-level estimates were poststratified to state population totals as reported in the Current Population Survey.
5. All statistical tests and standard errors used in the analysis reflect the complex survey design of MEPS, including the pooling of multiple years of data for the state estimates.
6. Banthin JS, Bernard DM. Changes in financial burdens for health care: national estimates for the population younger than 65 years, 1996 to 2003. JAMA. 2006;296(22):2712-9.
7. Comparisons with the earlier study by Banthin and colleagues (Note 1) show that differences in burden estimates based on before-tax or after-tax income are two percentage points or less. The differences were somewhat greater for higher-income people (3-4 percentage points). However, these small differences do not affect the trends and conclusions reported in this study.
8. U.S. Census Bureau. Table 646: GDP components in real (2000) dollars - annual percent change, 1990-2007. In: The 2009 statistical abstract. Washington (DC): Census Bureau; 2009.
9. Claxton G, Gabel J, DiJulio B, Pickreign J, Whitmore H, Finder B, et al. Health benefits in 2007: premium increases fall to an eight-year low, while offer rates and enrollment remain stable. Health Aff (Millwood). 2007;26(5):1407-16.
10. Kaiser Family Foundation/Health Research and Educational Trust. Employee health benefits: 2007 annual survey [Internet]. Washington (DC): Kaiser Family Foundation; 2007 [cited 2010 Mar 13]. Available from: http://www.kff.org/ insurance/7672/index.cfm
11. Gabel JR, McDevitt R, Lore R, Pickreign J, Whitmore H, Ding T. Trends in underinsurance and the affordability of employer coverage, 2004-2007. Health Aff (Millwood). 2009;28(4):w595-606.
12. Cunningham P, Felland LE. Falling behind: Americans' access to medical care deteriorates, 2003-2007. Washington (DC): Center for Studying Health System Change; 2008 Jun. Tracking Report no. 19.
13. The tests of statistical significance for the change between 2001-3 and 2004-6 determine whether the change in high burden and uninsured for each state is different from the national change.
14. The online Appendix is available by clicking on the Appendix link in the box to the right of the article online.
15. Estimates of the percentage of privately insured people in HMOs from MEPS are considerably higher than that reported in the KFF/HRET employer survey (about 38 percent in MEPS for 2004-6 versus 20 percent in the KFF/HRETsurvey in 2006; see Notes 9 and 10). This probably reflects differences in survey respondents' recall as well as in how respondents define HMO (for example, 13 percent of respondents to the KFF/HRET survey reported being in point-of-service plans; some MEPS respondents may have defined these as HMOs). These differences in point estimates are less consequential for this analysis, because the main focus is variation across states.
16. Congressional Budget Office. Geographic variation in health care spending. Washington (DC): CBO; 2008 Feb.
17. The conditions include sore throat, diabetes, asthma, high blood pressure, high cholesterol, heart disease, stroke, emphysema, joint pain, and arthritis. They were identified as "priority conditions" by AHRQ because of their relatively high prevalence in the population and because generally accepted standards of care have been developed for them.
18. Agency for Healthcare Research and Quality. MEPS HS-105: 2006 full year consolidated data file. Rockville (MD): AHRQ; 2008 Nov.
19. DeNavas-Walt C, Proctor BD, Smith JC. Income, poverty, and health insurance coverage in the United States: 2007. Washington (DC): U.S. Census Bureau; 2008 Sep. Current Population Reports no. P60-235.
20. Pauly MV, Pagan JA. Spillovers and vulnerability: the case of community uninsurance. Health Aff (Millwood). 2007;26(5):1304-14.
21. Furnas B, Buckwalter-Poza R. Health care competition: insurance market domination leads to fewer choices [Internet]. Washington (DC): Center for American Progress, 2009 Jun [cited 2010 Mar 13]. Available from: http://www.americanprogress.org/issues/2009/06/pdf/health-competitiveness.pdf