Explaining the Increase in Family Financial Pressures From Medical Bills Between 2003 and 2007: Do Affordability Thresholds Change Over Time?
Center for Studying Health System Change, Washington, DC 20024, USA. Medical Care Research and Review
(Impact Factor: 2.62).
06/2011; 68(3):352-66. DOI: 10.1177/1077558710378122
This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.
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ABSTRACT: PURPOSE Out-of-pocket cost sharing for health care expenses is a growing burden. Prior research has emphasized the medical consequences of cost sharing. This study investigates the range of social, medical, f nancial, and sometimes legal disruptions from high out-of-pocket health expenses. METHODS We conducted open-ended, semistructured interviews with 33 insured patients (two-thirds covered by Medicare). All had chronic illnesses and sought philanthropic f nancial assistance. RESULTS We found that high levels of cost sharing precipitated considerable anxiety and substantial debt problems, as well as disruptions of medical care. Participants described various borrowing strategies (eg, credit cards), legal problems (eg, debt collections), and threats to their nonmedical household budgets (eg, food, housing). Participants described explicit and rank-ordered strategies for coping with new medical expenses. Participants understood their health benef ts with exceptional detail but described considerable anxiety about changes to those benef ts that could easily disrupt carefully managed household budgets. Benef t designs that resulted in large a variations in f nancial liability from month to month (eg, large deductibles or coverage gaps) imposed considerable f nancial challenges. CONCLUSIONS As health care cost sharing grows, policy makers will need to consider the consequences of high cost sharing for families facing strained household budgets. Although the generosity of health insurance is important, continuity of benef ts and month-to-month stability of f nancial liability are also important and may be undervalued in policy discussions.
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This study aims to understand how do socio-demographic and personal factors impact the trade-offs people make in daily life in the USA due to problems in paying medical bills. Methods
This study used the 2007 wave of the Health Tracking Household Survey (HTHS) data. The unit of analysis was an individual. The dependent variable was the level of trade-off. A cumulative logit model measured the effect of independent variables on the dependent variable, which was ordinal. Key findingsPre-tax family income, out-of-pocket spending for medical care during past 12 months, perceived health status, type of family, ethnicity and age had significant impact on level of trade-off experienced by individuals. Odds of making severe trade-offs increased significantly for people with low income, poor self-reported general health status, higher out-of pocket medical expenditure and single parents. Compared to white people, African-Americans were worse affected because of problems in paying medical bills. Younger people made a higher level of trade-off compared to older people because of medical debt. Conclusions
Problems in paying medical bills forced people to forgo basic necessities of life, which could impact the nutritional status, access to health care and living condition of people. A higher level of trade-offs in daily life could potentially affect the health of an individual in the long run. Poor people were worst affected because of medical debt. This study could prompt policy makers to provide more support to indigent people, people with higher out-of-pocket medical expenses and those with poor health conditions to ensure adequate access to basic necessities of life.
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Although the proportion of people reporting problems paying medical bills has declined in the aftermath of the Great Recession, it is unclear if this decline has been caused by self-rationing of care, particularly among disadvantaged groups. We examined African American-White differences in problems paying medical bills prevalence along with factors which may account for observed differences.
We used cross-sectional data from 2007 (N = 13,064) and 2010 (N = 11,873) waves of the nationally representative, Health Tracking Household Survey. Logistic regression analyses, accounting for complex survey design and weights, were performed to compute population-based estimates.
Overall, the prevalence of problems paying medical bills was 18.3 % in 2007 and 19.8 % in 2010. African Americans more frequently reported having problems paying medical bills than Whites. Among African Americans, problems paying medical bills decreased from 30 % in 2007 to 25 % in 2010, which was largely explained by fewer problems reported by those in poor/fair health. Problems paying medical bills significantly declined from 44 % in 2007 to 33 % in 2010 for African Americans in poor/fair health, but remained almost constant for those in good health and very good/excellent health.
Our findings suggest that African Americans in poor health may be rationing or forgoing necessary care as a result of the recession, which could increase existing health disparities and future health spending. Efforts to reduce racial/ethnic disparities may depend on the extent to which the lingering effects of the Great Recession are mitigated.
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