Jan. 8, 2008
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More than one in six Americansor 17.7 percent of the nonelderly populationlived in families spending more than 10 percent of after-tax income on health care in 2004, up from 15.9 percent in 2001. Conducted by researchers at the Center for Studying Health System Change (HSC) and the Agency for Healthcare Research and Quality (AHRQ), the study defined people living in families spending more than 10 percent of after-tax income on health careincluding health insurance premium payments and direct spending on servicesas having a high financial burden.
After accounting for general inflation, total average out-of-pocket spending on health care increased by $373 to $2,656 a person in 2004about a 16 percent increase from 2001. In contrast, average family incomes during the same period were largely unchanged after accounting for inflation.
The increase in financial burden was driven entirely by people with private insurance, most of whom had employer-sponsored coverage: one in six people (17%), or 29 million people, with employer-sponsored insurance faced high burdens in 2004, up from one in seven people (14.7%) in 2001, the study found. For people with employer coverage, out-of-pocket spending for premiums and services rose $553 to $3,211, a 21 percent increase between 2001 and 2004 after accounting for inflation. The increase in high financial burden for this group would have been higher if not for a small rise (4.6%) in family incomes during the same period.
"Many families with private insuranceespecially those with low incomesare having difficulty paying medical bills," said HSC Senior Fellow Peter J. Cunningham, Ph.D., coauthor of the study with Jessica S. Banthin and Didem M. Bernard of AHRQ.
Commonwealth Fund Assistant Vice President Sara Collins said, "With the U.S. currently engaged in a national debate over expanding health insurance, these findings underscore how important it will be to ensure that everyone has access to insurance that covers essential services with premiums, deductibles and out-of-pocket-costs that are affordable relative to family income."
Given projections that overall private health insurance costs and out-of-pocket spending will rise 6 percent to 7 percent annually through 2016, the authors conclude that high financial burdens for health care are likely to continue to affect more Americans since growth in incomes is unlikely to keep pace with increases in the cost of care.
The Health Affairs article, titled "Financial Burden of Health Care, 2001-2004," is based on an analysis of AHRQs 2001 and 2004 Medical Expenditure Panel Survey. In both years, the survey included information on more than 28,000 people under age 65.
Other key study findings include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.