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Health Care Costs and Financing

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Despite health care system changes during the early 1990s, use of care and financial burden for the uninsured changed very little

Despite some fundamental changes in the health care system from 1987 to 1996, the overall experience of the uninsured changed very little during that time. In 1996, the uninsured continued to use fewer services and to pay more out of pocket for medical care than the privately insured, according to a study by researchers in the Center for Cost and Financing Studies, Agency for Healthcare Research and Quality.

Amy K. Taylor, Ph.D., Joel W. Cohen, Ph.D., and Steven R. Machlin, M.S., analyzed data from the 1996 Medical Expenditure Panel Survey and the 1987 National Medical Expenditure Survey to examine the use of medical services, expenditures, and burden of out-of-pocket spending for the uninsured and privately insured in both periods. The proportion of the noninstitutionalized civilian U.S. population under age 65 that was uninsured throughout the year increased from 11.6 percent in 1987 to 14 percent in 1996. During this period, the proportion of the full-year uninsured population that was under age 18 declined from 28 to 23 percent, likely due at least in part to initiation of Medicaid program expansions to cover low-income children.

At the same time, the proportion of the full-year uninsured population who were aged 30 and over increased from 39 to 47 percent, and the proportion of the uninsured who were employed for the full year grew from 39 percent to 55 percent. The composition of the uninsured population by race/ethnicity did not change substantially during this time. In both years, however, Hispanics were much more likely to be uninsured than those in other racial or ethnic groups.

The poor made up one-third of the uninsured in 1987, but only one-fourth of the uninsured by 1996. The proportion of the uninsured population in fair or poor health also declined between 1987 and 1996, from 18 percent to 11 percent of the total. The uninsured in fair or poor health, however, were more likely to have out-of-pocket expenses that constituted a high financial burden. More of this group, compared with the uninsured in good to excellent health, had out-of-pocket spending that equaled 20 percent or more of family income (9 vs. 5 percent in 1987 and 12 vs. 3 percent in 1996).

Use of services was much lower for the uninsured than for the insured in both years, and while the probability of having an outpatient hospital, office-based nonphysician, or dental visit increased for the privately insured, it remained unchanged for the uninsured. In addition, the uninsured were much less likely than the privately insured to use preventive services, such as blood pressure checks or mammograms, although use of the latter increased dramatically for both groups.

See "Being uninsured in 1996 compared to 1987: How has the experience of the uninsured changed over time?" by Dr. Taylor, Dr. Cohen, and Mr. Machlin, in a supplement to the December 2001 Health Services Research 36(6), Part II.

Reprints (AHRQ Publication No. 02-R038) are available from the AHRQ Publications Clearinghouse.

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