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Health Care Costs and Financing

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High costs of caring for a disabled family member may negatively affect receipt of needed care for other family members

Generally, having a disabled family member is associated with increased health care use and expenditures for family members without disabilities, including both children and adults under age 65. Regardless of the disability severity threshold used to identify the disabled family member, a recent study found that having a disabled family member increased overall family health expenditures and out-of-pocket spending compared with families without any disabled members.

As severity of disability rose, so did costs, so that families with a member with limitations in activities of daily living (for example, feeding oneself, using the toilet) on average spent about three times the amount that families without a disabled member spent for health care. Out-of-pocket medical expenses in this situation were more than 2.5 times greater for a family with a disabled member (11.2 percent vs. 4.1 percent of total income for families without a disabled member).

Among poor families, however, the effects of having a disabled member were more likely to reduce medical care use and expenditures among nondisabled family members. Adults in these families were 16 percent less likely to visit a doctor than adults in high-income families. Public programs need to recognize the potential rationing effect that occurs when income is limited and one family member uses the bulk of health care resources, note the authors of the study. It is possible that public programs are insuring only the disabled individual, leaving the rest of the family to manage on restrictive private policies or no insurance at all.

Adjusting income-level criteria for public health insurance when a family member is disabled or allowing buy-in opportunities (similar to those in the Medicare program that are now being considered for near-elderly people) are two possible approaches to this problem, suggest AHCPR researchers, Barbara M. Altman, Ph.D., and Philip F. Cooper, Ph.D., and their colleague Peter J. Cunningham, Ph.D., formerly of AHCPR and now with the Center for Studying Health System Change. Their findings are based on analysis of the 1987 household component of the National Medical Expenditure Survey. This survey provided national estimates of household health status, health care use, and expenditures based on a representative sample of the civilian, noninstitutionalized U.S. population.

See "The case of disability in the family: Impact on health care utilization and expenditures for nondisabled members," by Drs. Altman, Cooper, and Cunningham, in the Milbank Quarterly 77(1), pp. 39-75, 1999. Reprints (AHCPR Publication No. 99-R055) are available from the AHCPR Publications Clearinghouse.

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