1. 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

2. 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

3. 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

4. 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

5. 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: 4

6. 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

7. Change in 10% burdens by insurance status, 1996-200312

8. Change in 10% burdens by poverty status, 1996-200312

9. “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

10. Underinsured: change in burdens by insurance status, 1996-200312

11. 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

12. 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