Chronic Conditions, Medical Out-of-Pocket Expenditure Burden, and Perceived Health

This study examined the impact of medical out-of-pocket expenditure burden on being in a state of poor or fair health. Expenditures were self-reported payments for premiums, coinsurance, deductibles, and health services and supplies not covered by health insurance. The burden was measured as a ratio of total medical expenditures relative to family income. Supported by literature, several cutoffs (as opposed to just one threshold) were proposed to determine the critical point of increased health risk of medical financial burden. A treatment effects model was estimated recognizing that ratios are jointly influenced by other confounding factors such as chronic conditions. Data on 16,907 adults in the 2011 Medical Expenditure PanelSurvey were analyzed. The researchers concluded that ratios exceeding 10% increased the probability of reporting poor or fair health status. However, estimating this relationship while accounting for insurance but ignoring the presence of chronic conditions completely reversed this relationship. Sensitivity analysis suggested that insurance for those with chronic conditions does not lessen the negative impact of high out-of-pocket burdens, which seem to affect their perceived health. Implications are discussed relative to the goals of the Affordable Care Act.