Comparing Health Care Financial Burden With an Alternative Measure of Unaffordability

Abstract

Health insurance plans with high deductibles increase exposure to health care costs, raising concerns about how the growth in these plans may be impacting both the financial burden of health care expenditures on families and their access to health care. We find that foregoing medical care is common among low-income, privately insured families, occurring at a greater rate than those with higher incomes or Medicare coverage. To better understand the relationship between out-of-pocket (OOP) spending and access, we used the 2011-2014 Medical Expenditure Panel Survey (MEPS) data and a logistic model to analyze the likelihood of avoiding or delaying needed medical care based on health insurance design and other individual and family characteristics. We find that avoiding or delaying medical care is strongly correlated with coverage under a high-deductible health plan, and with depression, poor perceived health, or poverty. However, it is relatively independent of the percent of income spent on OOP costs, making the percent of income spent on OOP costs by itself a poor measure of health care unaffordability. Individuals who spend a small percentage of their income on health care costs may still be extremely burdened by their health plan when financial concerns prevent access to health care. This work emphasizes the importance of insurance design as a predictor of access and the need to expand the definition of financial barriers to care beyond expenditures, particularly for the low-income, privately insured population.

Income-Based Disparities in Financial Burdens of Medical Spending Under the Affordable Care Act in Families With Individuals Having Chronic Conditions

“…The observed changes in financial burdens may have only captured part of the medical spending for some families. 2 Thus, the financial burden of OOP medical spending for moderate-income individuals should be reevaluated in the near future.…”

“…1 Foregoing medical care due to affordability concerns was prevalent among uninsured nonelderly adults as well as those with private and public insurance sources. 2 This is an even more pressing concern for the half of Americans who have chronic physical and behavioral conditions, such as diabetes, hypertension, and mood disorders, which require continuing medical care. 3,4…”

0210 Healthcare Financial Hardship and Habitual Sleep Duration, Impact on Sleep Disparities, and Impact on the Sleep-Obesity Relationship

“…Also, short sleep is associated with a higher risk of hypertension, which is consistent with the current literature (Lusardi et al, 1999;Wang et al, 2015). Perhaps because avoided medical care increases risks for the chronic conditions on its own and causes poorer health management (Kielb, Rhyan, & Lee, 2017), to the point that it overshadows the effects of sleep, even though it does seem to affect sleep. Increased health risks are associated with access to medical care since forgoing medical care prevents individuals to take the medication needed for their disease or disorder, which intensifies their disease and illness.…”

Regional Differences in Serious Psychological Distress and Overall Physical and Mental Health

“…The burden ratio was calculated by dividing this amount by the total household income, as previously defined. Burden ratios exceeding 10% were considered financially burdened (Kielb et al, 2017 ).…”