Medical Bankruptcy in the United States, 2007: Results of a National Study

Himmelstein, David U.; Thorne, Deborah; Warren, Elizabeth; Woolhandler, Steffie

doi:10.1016/j.amjmed.2009.04.012

Cited by 627 publications

(322 citation statements)

References 4 publications

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“…One reason these caps are of interest is that being "underinsured"-having insurance and yet being exposed to a high level of financial risk 1 -and the associated financial burden contribute to numerous adverse consequences, such as non-compliance, 2 delayed or forgone care, 3 and bankruptcy. 4 The recent health care reform was largely motivated by the "crisis" of high uninsurance, 5 and much of the attention generated by the ACA has focused on the new Health Insurance Marketplace ("exchanges") and the eight million Americans who signed up during the initial open enrollment. 6 However, reform was also motivated to improve insurance and lower costs for all Americans, and since the majority of non-elderly Americans will remain covered by insurance obtained through their employers, provisions in the ACA that affect group (i.e., employer-sponsored) insurance have the potential to impact the financial burden of many more individuals than the exchanges.…”

Section: Introductionmentioning

confidence: 99%

Impact of Out-of-Pocket Spending Caps on Financial Burden of those with Group Health Insurance

2014

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BACKGROUND:The Affordable Care Act (ACA) mandates that all private health insurance include outof-pocket spending caps. Insurance purchased through the ACA's Health Insurance Marketplace may qualify for income-based caps, whereas group insurance will not have income-based caps. Little is known about how out-of-pocket caps impact individuals' health care financial burden. OBJECTIVE: We aimed to estimate what proportion of non-elderly individuals with group insurance will benefit from out-of-pocket caps, and the effect that various cap levels would have on their financial burden. DESIGN: We applied the expected uniform spending caps, hypothetical reduced uniform spending caps (reduced by one-third), and hypothetical income-based spending caps (similar to the caps on Health Insurance Marketplace plans) to nationally representative data from the Medical Expenditure Panel Survey (MEPS). PARTICIPANTS: Participants were non-elderly individuals (aged < 65 years) with private group health insurance in the 2011 and 2012 MEPS surveys (n =26,666). MAIN MEASURES: (1) The percentage of individuals with reduced family out-of-pocket spending as a result of the various caps; and (2) the percentage of individuals experiencing health care services financial burden (family outof-pocket spending on health care, not including premiums, greater than 10 % of total family income) under each scenario. KEY RESULTS: With the uniform caps, 1.2 % of individuals had lower out-of-pocket spending, compared with 3.8 % with reduced uniform caps and 2.1 % with income-based caps. Uniform caps led to a small reduction in percentage of individuals experiencing financial burden (from 3.3 % to 3.1 %), with a modestly larger reduction as a result of reduced uniform caps (2.9 %) and incomebased caps (2.8 %). CONCLUSIONS: Mandated uniform out-of-pocket caps for those with group insurance will benefit very few individuals, and will not result in substantial reductions in financial burden.KEY WORDS: health insurance; health reform; health care costs.

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Section: Introductionmentioning

confidence: 99%

Impact of Out-of-Pocket Spending Caps on Financial Burden of those with Group Health Insurance

2014

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“…15 Although these tensions remain largely unresolved today, several trends have arisen that create opportunities for academic GIM. Growing economic and political pressures to reduce health care costs [16][17][18] and increase value have led to new models of primary care that focus on population management, health outcomes and medical teams, rather than episodic individual-based care from a single provider. 19,20 Similarly, public and private insurers are experimenting with new payment models, such as accountable care and bundled care, that focus incentives on quality and efficiency of care.…”

Section: Introductionmentioning

confidence: 99%

Academic General Internal Medicine: A Mission for the Future

et al. 2013

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After five decades of growth that has included advances in medical education and health care delivery, value cohesion, and integration of diversity, we propose an overarching mission for academic general internal medicine to lead excellence, change, and innovation in clinical care, education, and research. General internal medicine aims to achieve health care delivery that is comprehensive, technologically advanced and individualized; instills trust within a culture of respect; is efficient in the use of time, people, and resources; is organized and financed to achieve optimal health outcomes; maximizes equity; and continually learns and adapts. This mission of health care transformation has implications for the clinical, educational, and research activities of divisions of general internal medicine over the next several decades.

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“…Indeed, the percentage of personal bankruptcies in the United States attributed to health care costs rose from 46.2% in 2001 to 69.1% in 2007. 7 More concerning, health care reform in Massachusetts (the template for national health care reform) did not seem to decrease the percentage of personal bankruptcies due to health care costs. 8 As serious as the problems are in the United States, there are additional issues in less wealthy countries, where resources are considerably constrained.…”

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confidence: 98%