Sept. 16, 2010
Medical Care Research and Review , OnlineFirst
Peter J. Cunningham
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 billsdefined as the percent with problems paying medical billsincreased between 2003 and 2007, greater out-ofpocket 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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