Jessica Banthin, Ph.D December 11, 2007

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Presentation transcript:

Jessica Banthin, Ph.D December 11, 2007 Who are the Underinsured? High Out of Pocket Burdens among Insured Families Jessica Banthin, Ph.D December 11, 2007

Growth in Financial Out of Pocket Burdens, 1996 to 2003, (10% burdens) Among total U.S. population: In 1996, 15.8% or 37.3 million persons In 2003, 19.2% or 48.8 million persons Spent more than 10% of adjusted family income on out of pocket health care costs, including premiums, deductibles, co-pays, Representing an increase of 11.7 million persons with high financial burdens

Growth in Financial Out of Pocket Burdens, 1996 to 2003 (20% burdens) Among total U.S. population: In 1996, 5.5% or 12.9 million persons In 2003, 7.3% or 18.7 million persons Spent more than 20% of adjusted family income on out of pocket health care costs, including premiums, deductibles, co-pays, Representing an increase of 5.8 million persons with very high financial burdens

Research Questions How have rising health care costs effected family budgets? How are out of pocket health care costs distributed among individuals and families by insurance and income status? Who are most likely to have high burdens, in general? Among the privately insured, who are most likely to have high burdens? 4

Data: Medical Expenditure Panel Survey 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 data on out of pocket spending for medical care Released on public use files, tables, statistical briefs: www.meps.ahrq.gov 4

Denominator: We calculated total family income and adjusted for taxes Methods 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% or more than 20% of family income on out of pocket expenses Results are presented in terms of numbers or percent of individuals living in families with high financial burdens 4

Change in 10% burdens by insurance status, 1996-2003 12

Change in 10% burdens by poverty status, 1996-2003 12

“Underinsured” Underinsured are defined as persons covered by private insurance who spend 10% or more of family income on out of pocket payments for deductibles, co-pays, and uncovered services. 4

Underinsured: change in burdens by insurance status, 1996-2003 12

Chronic Disease Likelihood of having 10% total burden: Diabetes, 39% Stroke, 56% Heart disease, 33% Hypertension, 31% Arthritis, 31% Mental disorder, 29% Back problems, 25%E 4

What contributes to high burdens? Among publicly insured, prescription drug expenditures make up 2/3 of out of pocket spending on services. They pay about 15% of total out of pocket. Persons with non-group coverage pay for more than ½ of total expenditures out of pocket, compared to 1/3 for ESI private coverage. Uninsured pay for about ¾ of total expenditures out of pocket 4