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Health Care Costs, and Financing

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The financial burden of health care for people under age 65 increased between 1996 and 2003

From 1996 to 2003, the financial burden of health care in the United States for people less than 65 years of age increased, especially among the poor and those with job-related and public insurance coverage. By 2003, there were 48.8 million individuals (19 percent) living in families who spent more than 10 percent of family income on medical care, an increase of 11.7 million people since 1996. Of those, 18.7 million individuals (7 percent) lived in families spending more than 20 percent of family income on medical care.

An estimated 17.1 million people younger than 65 years were underinsured in 2003, including 9.3 million people with private employment-related insurance, 1.3 million people with private nongroup policies, and 6.6 million people with public coverage. People with nongroup plans were nearly three times as likely to bear high total burdens as individuals in any other insurance category. Others at higher-than-average risk of incurring financial burdens were poor and low-income people, the nonelderly, those in fair or poor health, those with a limitation in functioning, people suffering from a chronic medical condition, or those living in a nonmetropolitan area.

High out-of-pocket burdens (for all health care services, including insurance premiums) were associated with delaying or foregoing medical care for financial reasons. For example, about 5 percent of people with a 20 percent total health care financial burden in 2003 reported that they were unable to receive treatment for financial reasons compared with 2.1 percent of people with lower burdens. Similarly, 4.4 percent of people with 20 percent total burdens compared with 2 percent of people with lower burdens reported that they delayed receiving treatment for financial reasons. This behavior can have severe consequences for those in poor health, note Jessica S. Banthin, Ph.D., and Didem M. Bernard, Ph.D., of the Agency for Healthcare Research and Quality. Their findings were based on analysis of data from the Medical Expenditure Panel Surveys in 1996 and 2003 of noninstitutionalized, nonelderly people.

See "Changes in financial burdens for health care: National estimates for the population younger than 65 years, 1996-2003," by Drs. Banthin and Bernard, in the December 13, 2006, Journal of the American Medical Association 296(22), pp. 2712-2719. Reprints (AHRQ Publication No. 07-R022) are available from the AHRQ Publications Clearinghouse.

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