Financial Burdens for Health Care (Text Version)

AHRQ 2008 Annual Conference

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Jessica Banthin, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (715 KB; Plugin Software Help).

Slide 1

Financial Burdens for Health Care

Jessica Banthin, Ph.D.
Didem Bernard, Ph.D.
September 9, 2008

Slide 2

Research Questions

• How have rising health care costs affected family budgets?
• How does risk of high out of pocket health care burdens vary by:
  • Insurance status.
  • Income categories.
  • Age and gender.
  • Presence of chronic conditions.

Slide 3

Data: Medical Expenditure Panel Survey (MEPS)

• The MEPS is annual survey sponsored by Agency for Healthcare Research & Quality.
• Nationally representative household survey consisting of 15,000 households and 39,000 individuals.
• Includes data on insurance coverage, health care utilization and expenditures, health status, medical conditions, & more.
• Most accurate source of nationally representative micro level data on out of pocket spending for medical care.
• Released on public use files, tables, statistical briefs: http://meps.ahrq.gov

Slide 4

Methods: Constructing Measure of High Burden

• Numerator: We calculated total out of pocket spending across all individuals in the family.
• Denominator: We calculated total family income and adjusted for taxes.
• We identify individuals living in families that spend more than 10% of family income on out of pocket expenses—"high burden."
• Results are presented in terms of percent of individuals living in families with high financial burdens.

Slide 5

Methodological Considerations

• Burden ratio (% of family income) is a composite or summary measure compressing many variables into one ratio.
• Provides big picture—no causal interpretation.
• Combines out-of-pocket (OOP) premiums plus OOP payments on services.
• Defines burdens at family level because family members share resources.
• Use 10 percent of adjusted family income as reasonable threshold, other thresholds can be used.

Slide 6

The line graph presents the total "Percent Spending 10% or More of Family Income on Out of Pocket Expenditures." The vertical axis, percent, goes from 14 to 19.5 and the horizontal axis, year, goes from 2001 through 2005. The results:

• 2001: 15.9%
• 2002: 17.2%
• 2003: 18.9%
• 2004: 17.9%
• 2005: 19.1%

Slide 7

The line graph presents the "Percent Spending 10% or More of Family Income by Insurance Status." The vertical axis, percent, goes from 0 to 60 and the horizontal axis, year, goes from 1 to 5. The results:

• Private:
  • 1: 14.7%
  • 2: 16.0%
  • 3: 17.8%
  • 4: 17.0%
  • 5: 18.6%
• Private Non-Group:
  • 1: 39.0%
  • 2: 49.1%
  • 3: 55.3%
  • 4: 52.7%
  • 5: 52.9%
• Public:
  • 21: 18.0%
  • 2: 18.0%
  • 3: 19.5%
  • 4: 15.8%
  • 5: 16.5%
• Uninsured All Year:
  • 1: 13.9%
  • 2: 13.7%
  • 3: 13.5%
  • 4: 14.0%
  • 5: 15.0%

Slide 8

The line graph presents the "Percent Spending 10% or More of Family Income by Poverty Status." The vertical axis, percent, goes from 0 to 40 and the horizontal axis, year, goes from 2001 through 2005. The results:

• Poor (<100%):
  • 2001: 30.3%
  • 2002: 31.4%
  • 2003: 33.6%
  • 2004: 28.1%
  • 2005: 29.0%
• Low Income (<200%):
  • 2001: 22.9%
  • 2002: 21.4%
  • 2003: 24.2%
  • 2004: 23.8%
  • 2005: 21.9%
• Lo-Middle (<300%):
  • 2001: 20.3%
  • 2002: 22.9%
  • 2003: 25.1%
  • 2004: 21.1%
  • 2005: 23.4%
• Hi-Middle (<400%):
  • 2001: 14.3%
  • 2002: 17.0%
  • 2003: 19.0%
  • 2004: 16.3%
  • 2005: 21.9%
• High Income (400% plus):
  • 2001: 7.2%
  • 2002: 8.2%
  • 2003: 9.0%
  • 2004: 10.2%
  • 2005: 11.3%

Slide 9

The line graph presents the "Percent Spending 10% or More of Family Income by Age/Gender." The vertical axis, percent, goes from 0 to 35 and the horizontal axis, year, goes from 2001 through 2005. The results:

• Less than 18:
  • 2001: 15.4%
  • 2002: 16.8%
  • 2003: 18.2%
  • 2004: 16.0%
  • 2005: 17.6%
• Males 19-34:
  • 2001: 9.0%
  • 2002: 10.6%
  • 2003: 11.5%
  • 2004: 10.6%
  • 2005: 12.1%
• Females 19-34:
  • 2001: 13.6%
  • 2002: 15.0%
  • 2003: 16.9%
  • 2004: 14.9%
  • 2005: 16.7%
• Males 35-49:
  • 2001: 14.0%
  • 2002: 15.0%
  • 2003: 16.0%
  • 2004: 14.9%
  • 2005: 16.9%
• Females 35-49:
  • 2001: 16.5%
  • 2002: 16.9%
  • 2003: 18.9%
  • 2004: 18.4%
  • 2005: 19.5%
• Males 50-64:
  • 2001: 21.5%
  • 2002: 22.6%
  • 2003: 25.3%
  • 2004: 25.4%
  • 2005: 25.8%
• Females 50-64:
  • 2001: 26.6%
  • 2002: 27.9%
  • 2003: 30.7%
  • 2004: 30.3%
  • 2005: 30.2%

Slide 10

The line graph presents the "Percent Spending 10% or More of Family Income by Insurance Status and Chronic Condition." The vertical axis, percent, goes from 0 to 30 and the horizontal axis, year, goes from 2001 through 2005. The results:

• INSRD_CHR:
  • 2001: 19.79%
  • 2002: 21.52%
  • 2003: 24.84%
  • 2004: 23.08%
  • 2005: 24.42%
• INSRD_NON:
  • 2001: 13.2%
  • 2002: 14.32%
  • 2003: 15.1%
  • 2004: 13.73%
  • 2005: 15.31%
• UNINSRD_CHR:
  • 2001: 25.43%
  • 2002: 25.77%
  • 2003: 25.28%
  • 2004: 25.63%
  • 2005: 26.67%
• UNINSRD_NON:
  • 2001: 8.82%
  • 2002: 8.15%
  • 2003: 8.23%
  • 2004: 8.56%
  • 2005: 9.32%

Slide 11

Financial Burdens by Chronic Disease 2003

Likelihood of facing high financial burden:

• All persons, 19.2%
• Diabetes, 39.1%
• Stroke, 56.0%
• Heart disease, 32.7%
• Hypertension, 30.9%
• Arthritis, 30.7%
• Mental disorder, 29.2%

Slide 12

Conclusion

• Tracking trends in high financial burdens provides policymakers with overview of issue.
• Identifies subgroups with elevated risk for high burdens.
• Helps inform debate on affordability issue.
• Also provides benchmark against which to measure proposed changes in policy.