Risk of Burdensome Health Care Spending Over Time in the US

Area of Science:

• Health Economics
• Public Health Policy
• Longitudinal Health Studies

Background:

• Cross-sectional studies suggest out-of-pocket (OOP) healthcare costs burden US households.
• Longitudinal data on the risk and prevalence of burdensome healthcare spending are limited.

Purpose of the Study:

• To assess the incidence of burdensome OOP healthcare costs and care foregone due to cost over a 4-year period in the US.
• To identify risk factors associated with incurring significant OOP medical spending.

Main Methods:

• Analysis of 4-year longitudinal data from the Medical Expenditure Panel Surveys (MEPS), a nationally representative US household survey (2018-2022).
• Time-to-event analyses were used to assess risk of cost burden, catastrophic cost burden (CCB), foregone care, and family-level cost burden.
• Subgroup analyses included individuals with chronic disease, prior hospitalizations, and those uninsured.

Main Results:

• Over 4 years, 17.4% of adults experienced cost burdens and 9.9% experienced catastrophic cost burdens (CCB).
• 24.7% of individuals lived in families with cost burdens, and 11.2% in families with CCBs.
• Lower income, lack of insurance, hospitalizations, and chronic diseases were associated with higher cost burdens; 53.2% of decedents experienced cost burdens prior to death.

Conclusions:

• The US healthcare system places financial burdens on a larger population segment than previously estimated.
• Most individuals will experience healthcare cost burdens during their lifetime.
• Policies aimed at reducing OOP costs could enhance population well-being.