Mental Health and Family Out-of-Pocket Expenditure Burdens

Zuvekas, Samuel H.; Selden, Thomas M.

doi:10.1177/1077558709345499

Cited by 22 publications

(15 citation statements)

References 25 publications

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“…Cost sharing may disproportionately affect people with mental illness, who have lower family incomes and are more likely to be living in poverty than those without mental illness. 12,13 …”

Section: Insurance Coverage Costs and Access To Carementioning

confidence: 99%

Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999–2010

2013

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The cost of mental health services has always been a great barrier to accessing care for people with mental health problems. This article documents changes in insurance coverage and cost for mental health services for people with public insurance, private insurance, and no coverage. Compared to 1999–2000, in 2009–10 people with mental health problems were more likely to have public insurance and less likely to have private insurance. Although access to specialty care remained relatively stable for people with mental illness, cost barriers to care increased among the uninsured and the privately insured who had serious mental illness. The rise in cost barriers among those with private insurance suggests that the current financing of care in the private insurance market is insufficient to alleviate cost burdens and has implications for reforms under the Affordable Care Act. People with mental health problems who are newly eligible to purchase private insurance under the act might still find high cost barriers to accessing care.

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“…Cost sharing may disproportionately affect people with mental illness, who have lower family incomes and are more likely to be living in poverty than those without mental illness. 12,13 …”

Section: Insurance Coverage Costs and Access To Carementioning

confidence: 99%

Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999–2010

2013

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“…38 This may be due to physical or mental disability in disabled patients leading to job loss or reduced earnings, while higher medical care needs due to disability increase the burden of high medical costs. 39 Even relatively small expenditures are catastrophic for poor families, and excessive out-of-pocket health care spending can lead to poverty. 40 The medical insurance system has poorly accurate identi cation of vulnerable characteristics, which in turn affects the economic protection ability of the medical insurance system for patients with cardiovascular diseases.…”

Section: Discussionmentioning

confidence: 99%

Does the Medical Insurance System Play a Real Role in Reducing Catastrophic Economic Burden in Elderly Patients with Cardiovascular Disease in China? Implication for Accurately Targeting Vulnerable Characteristics.

Wang

et al. 2020

Preprint

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Background: The vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, can cause such people to bear the economic burden of the disease due to the use of medical services.We estimated the economic burden of patients with CVD,and identified the weak link in the design of the medical insurance.Methods: Data from 5,610 middle-aged and elderly with CVD were drawn from the 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). The recommended method of the World Health Organization (WHO) was adopted to calculate catastrophic health expenditure (CHE), impoverishment by medical expenses (IME), and applied the treatment-effect model to analyze the determinants of CHE.Results: The incidence of CHE was 19.9% of the CVD, compared to 7.6% of the sample households trapped in IME. The incidence of CHE in CVD participating in medical insurance was 2.6% higher than for uninsured families (16.3%).Family size, health satisfaction,combine with other chronic diseases, having hospitalization and disabled members, and participating in insurance were found to be significantly associated with the likelihood of CHE.Conclusions: Elderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD, but lacked policy inclination for high-utilization populations,and had poorly accurate identification of vulnerable characteristics of CVD,which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security systems leads to the existence of blind spots in the economic risk protection of individuals and families.

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“…Third, high medical financial burdens are summarized in a binary variable taking a value of 1 if medical out‐of‐pocket expenditures account for more than 10 percent of total family income and 0 otherwise. In this calculation, the denominator is the maximum of total family income and $1000 . Financial variables are converted to 2013 values using a Gross Domestic Product deflator .…”

Section: Data Variables and Methodsmentioning

confidence: 99%

“…In this calculation, the denominator is the maximum of total family income and $1000. 21,22 Financial variables are converted to 2013 values using a Gross Domestic Product deflator. 23 These calculations are at the family level because co-residing family members share resources.…”

Section: Outcome Variablesmentioning

confidence: 99%

Effects of improvements in the CPS on the estimated prevalence of medical financial burdens

Hill

Solomon

Maclean

2019

Health Services Research

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Objective To measure the effects of questionnaire and imputation improvements in the Current Population Survey (CPS) on the estimated prevalence of high medical financial burden, that is, families spending more than 10 percent of income on medical care. Data Source Matched longitudinal sample of CPS data for 2013 and 2014 calendar years. Study Design The CPS used a split‐sample design to field traditional and redesigned questions about 2013 income, and old and new out‐of‐pocket premium imputation procedures, respectively. For both samples, CPS data for 2014 were from the redesigned income questions and the new imputation procedures. We quantify the effects of the combined survey improvements using differences‐in‐differences methods. Principal Findings The improvements were not associated with changes in the estimate of burden in the full sample. Estimated prevalence increased by 2.6 percentage points among nonelderly adults with private insurance, decreased by 6.6 percentage points among nonelderly adults with public coverage, and decreased by 5.8 percentage points among elderly adults with Medicare and no private coverage. Conclusions Improvements in the CPS changed the estimated prevalence of high medical financial burden among key subgroups. Researchers should use caution when tracking burden across the time‐period in which these improvements were implemented.

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Mental Health and Family Out-of-Pocket Expenditure Burdens

Cited by 22 publications

References 25 publications

Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999–2010

Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999–2010

Does the Medical Insurance System Play a Real Role in Reducing Catastrophic Economic Burden in Elderly Patients with Cardiovascular Disease in China? Implication for Accurately Targeting Vulnerable Characteristics.

Effects of improvements in the CPS on the estimated prevalence of medical financial burdens

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