For Your Eyes Only: Changes in Financial Burdens for Health Care

[Henk Elegeert]

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http://jama.ama-assn.org/cgi/content/abstract/296/22/2712
JAMA -- Abstract: Changes in Financial Burdens for
Health Care: National Estimates for the Population
Younger Than 65 Years, 1996 to 2003, December 13,
2006, Banthin and Bernard 296 (22): 2712

"
Changes in Financial Burdens for Health Care

National Estimates for the Population Younger Than
65 Years, 1996 to 2003

Jessica S. Banthin, PhD; Didem M. Bernard, PhD

JAMA. 2006;296:2712-2719.

Context  Policymakers as well as physicians need to
understand how rapidly rising health care costs are
affecting specific groups of patients.

Objective  To estimate the number and
characteristics of individuals in the United States
faced with very high financial burdens for health care.

Design, Setting, and Population  Data from a
nationally representative sample of civilian,
noninstitutionalized US individuals younger than 65
years from the Medical Expenditure Panel Surveys
were used to calculate 2 measures of financial
burden as a function of tax-adjusted family income.
Total burden included all out-of-pocket expenditures
for health care services, including premiums. Health
care services burden excluded premiums and, when
applied to the insured population, was used to
identify the underinsured. We defined the
underinsured as insured persons with health care
service burdens in excess of 10% of tax-adjusted
family income.

Main Outcome Measures  Total and health care
services burdens exceeding 10% and 20% of family
income in 1996 and 2003.

Results  In 2003, there were 48.8 million
individuals (19.2%) living in families spending more
than 10% of family income on health care, an
increase of 11.7 million persons since 1996. Of
these individuals, about 18.7 million (7.3%) were
spending more than 20% of family income. In 2003,
individuals with higher-than-average risk of
incurring high total burdens included poor and
low-income persons and those with nongroup coverage,
aged 55 to 64 years, living in a non–metropolitan
statistical area, in fair or poor health, having any
type of limitation, or having a chronic medical
condition. Applying our definition of underinsured
to the insured population, an estimated 17.1 million
persons younger than 65 years were underinsured in
2003, including 9.3 million persons with private
employment-related insurance, 1.3 million persons
with private nongroup policies, and 6.6 million
persons with public coverage.

Conclusions  Our analysis identifies patients at
greatest risk of health-related financial burdens
that may adversely affect their access and adherence
to recommended treatments. Our study also highlights
the high costs associated with nongroup health
insurance policies.


Author Affiliations: Division of Modeling and
Simulation, Center for Financing, Access and Cost
Trends, Agency for Healthcare Research and Quality,
US Department of Health and Human Services,
Rockville, Md.
"

Henk Elegeert

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