How does family health care use respond to economic shocks? realized and anticipated effects

Abstract

Families in constrained economic circumstances resulting from economic shocks face difficult choices regarding how best to spend their diminished resources. As families strive to preserve their living standards, decisions regarding health care use and its allocation among family members may become more discretionary and complex. Using two-year panel data from the Medical Expenditure Panel Survey for 2004 to 2011, we examine how the intra-family allocation of health care spending responds to realized and anticipated changes in family economic status. We focus on the share of total family health care spending allocated to children, and measure realized economic shocks based on changes in the family's income, employment, and health insurance status. We account for anticipated economic shocks by differentiating families by whether they are observed prior to, at the onset of, or during the Great Recession, or in the post-recession period. Our findings suggest that both types of economic shocks affect the share of family health care spending allocated to children, with findings more pronounced for single-mother families. We also find that realized economic shocks have a greater impact on children's spending share than the anticipated change in economic status associated with the Great Recession and its recovery.

Selection of private or public hospital care: examining the care-seeking behaviour of patients with private health insurance

“…Lifestyle variables consisted of physical activity (less than once a week, 1-3 times a week, more than three times per week) and smoking status (non-smoker, occasional smoker, regular smoker). Health shocks (illness) or financial distress can influence the choice of healthcare utilisation [32,33]. Therefore, health shocks and financial distress were measured thus: serious personal illness (yes =1, no = 0) and major worsening in finances (yes =1, no = 0), either of these in the last twelve months.…”

How Do Economic Shocks Affect Family Health Care Spending Burdens?

“…Finally, we further examine whether the change in its out-of-pocket health care spending burden is differentially borne by single-mother families compared to two-parent families. In earlier work examining the impact of economic shocks on the intra-family allocation of health care spending between adults and children (Monheit, Grafova, and Kumar 2018), we found that the response was largely due to the behavior of single-mother families.…”

“…2 For consistency with our earlier analyses of economic shocks and family health security (Monheit, Grafova, and Kumar, 2018;Grafova, Monheit and Kumar 2018;and Monheit and Grafova, 2018), we rely on data for this period.…”

How Do Economic Shocks Affect Family Health Care Spending Burdens?

“…2 Since the focus of our analysis is on the family's health care spending burden, we constructed family units and obtained family-level characteristics for each year of our two-year panels based on the characteristics of individual family members, family-level income, the insurance status of each family member, and each parent's employment history. Our sample of families consists of those with all members present for both years of the two-year panel and who 2 For consistency with our earlier analyses of economic shocks and family health security (Monheit, Grafova, and Kumar, 2018;Grafova, Monheit and Kumar 2018;and Monheit and Grafova, 2018), we rely on data for this period.…”