Private Health Insurance and Risk Protection: Changes in Out-of-Pocket Medical Spending, 2001 and 2011
- 27 Downloads
Changes in the cost-sharing provisions of employment-sponsored health insurance in the 2000s were designed to control U.S. health-care spending. However, such provisions may also increase the financial burden on families who need medical care and may differentially affect families according to their socioeconomic characteristics and the health status of family members. Additionally, changes in cost sharing may alter the entire shape of the out-of-pocket spending distribution. Using quantile regressions, I assess whether the distribution of out-of-pocket spending and hence the risk-protection function of private insurance has been affected by such changes. The empirical results reveal that families who are likely to incur higher health-care spending because of family members’ existing health conditions were most affected by changes in cost sharing, while families with older policyholders at higher percentiles of the out-of-pocket spending distribution experienced decreases in such spending.
Keywordsprivate health insurance risk protection out-of-pocket medical spending quantile regression
I am deeply indebted to Alan Monheit for his guidance and persistent encouragement. I also thank Louise Russell, Hilary Sigman, and two anonymous referees for helpful discussions and comments. All errors are mine.
- Agency for Healthcare Research and Quality (2011) ‘Tables for total expenses and per cent distribution for selected conditions by type of service: United States’, from www.meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&File=HCFY2011&Table=HCFY2011_CNDXP_C&_Debug=, accessed July 2014.
- Centers for Medicare & Medicaid Services (CMS), ‘National Health Expenditure Tables’, from www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/tables.pdf, accessed July 2014.
- Fronstin, P. (2004) Health Savings Accounts and Other Account-Based Health Plans, EBRI Issue Brief No. 273. Washington DC: Employee Benefit Research Institute.Google Scholar
- Goldman, D.P. and Smith, J.P. (2001) ‘Methodological biases in estimating the burden of out-of-pocket expenses’, HSR: Health Services Research 35 (6): 1357–1370.Google Scholar
- Kaiser Family Foundation and Health Research and Educational Trust (2001) Employer Health Benefits—2001 Annual Survey, from http://kaiserfamilyfoundation.files.wordpress.com/2013/04/6458.pdf, accessed July 2014.
- Kaiser Family Foundation and Health Research and Educational Trust (2011) Employer Health Benefits—2011 Annual Survey, from http://kaiserfamilyfoundation.files.wordpress.com/2013/04/8225.pdf, accessed July 2014.
- Schoen, C., Doty, M.M., Collins, S.R. and Holmgren, A.L. (2005) ‘Insured but not protected: How many adults are underinsured?’ Health Affairs (suppl web exclusives): W5.289–W5.302.Google Scholar
- Taylor, A.K, Crimmel, B.L. and Zawacki, A.M. (2006) Changes in Out-of-Pocket Maximum Limits for Employer Sponsored Health Insurance plans 1999–2003, Agency for Healthcare Research and Quality Statistical Brief #128.Google Scholar