Effects of improvements in the CPS on the estimated prevalence of medical financial burdens

Abstract

Objective To measure the effects of questionnaire and imputation improvements in the Current Population Survey (CPS) on the estimated prevalence of high medical financial burden, that is, families spending more than 10 percent of income on medical care. Data Source Matched longitudinal sample of CPS data for 2013 and 2014 calendar years. Study Design The CPS used a split‐sample design to field traditional and redesigned questions about 2013 income, and old and new out‐of‐pocket premium imputation procedures, respectively. For both samples, CPS data for 2014 were from the redesigned income questions and the new imputation procedures. We quantify the effects of the combined survey improvements using differences‐in‐differences methods. Principal Findings The improvements were not associated with changes in the estimate of burden in the full sample. Estimated prevalence increased by 2.6 percentage points among nonelderly adults with private insurance, decreased by 6.6 percentage points among nonelderly adults with public coverage, and decreased by 5.8 percentage points among elderly adults with Medicare and no private coverage. Conclusions Improvements in the CPS changed the estimated prevalence of high medical financial burden among key subgroups. Researchers should use caution when tracking burden across the time‐period in which these improvements were implemented.

Does Marijuana Legalization Affect Work Capacity? Evidence from Workers’ Compensation Benefits

“…We are concerned that this unprecedented public health crisis may have impacted reporting.19 The American Community Survey (ACS) does not collect information specifically on WC benefit receipt. We cannot isolate income from WC from other sources, thus the ACS is not suitable for our research question.20 There was a change in the ordering of some of the income questions in 2014 in the ASEC(Hill et al 2019). We do not suspect that this change impacts our analysis since we include year fixed effects in all regression models, accounting for such national changes.…”

Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid

“…Finally, we assessed two measures of out‐of‐pocket spending: a continuous measure of amounts spent for all health care in dollars and a binary indicator of whether the person was part of family that collectively spent more than 5% of their family income on medical care, a measure of out‐of‐pocket burden for families with low incomes consistent with limits on out‐of‐pocket spending in Medicaid 23 . In this calculation, the denominator is the maximum of total family income and $1000 24 …”

Out-of-Pocket Medical Expenditures in the Redesigned Current Population Survey: Evaluating Improvements to Data Processing

“…To understand the burden of medical expenses on family economic well-being, we also examine the percentage of people facing a high burden from medical spending across these two files. Consistent with past analyses, we defined high medical burden as people who have family medical expenditures that are at least 10% of the family’s income (Hill et al, 2019). Next, we compare the characteristics of people with high medical burden across legacy and updated processing.…”

“…Household medical expenditures are a significant factor affecting health care utilization and household financial well-being (Banthin et al, 2008; Christopher et al, 2018). While administrative records can be used to ascertain some costs, household surveys are an important source of comprehensive information on premium and nonpremium medical spending, high medical burden (expenses are at least 10% of family income in keeping with prior studies (Hill et al, 2019), and on the demographic and socioeconomic characteristics of the household. The Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is widely used as a source of information on the nation’s health insurance coverage and medical expenditures (Berchick et al, 2019).…”