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Medical Care Needs in Poverty Thresholds

Medical Care Needs in Poverty Thresholds. Jessica S. Banthin Agency for Healthcare Research and Quality U.S. Department of Health and Human Services. Why Such Controversy?. In U.S. there are now 43.6 million people without health insurance coverage Imperfect markets for health insurance

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Medical Care Needs in Poverty Thresholds

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  1. Medical Care Needs in Poverty Thresholds Jessica S. Banthin Agency for Healthcare Research and Quality U.S. Department of Health and Human Services

  2. Why Such Controversy? • In U.S. there are now 43.6 million people without health insurance coverage • Imperfect markets for health insurance • Public insurance for low income is limited • Major policy issue high on the political agenda • Disparities in access to care, ability to pay for needed care, with resulting health consequences

  3. Is Health Care a Basic Need? • Health care is a basic need like food, shelter, and clothing, but… • Much greater variation • Lots of uncertainty surrounding needs • Incomplete insurance and imperfect markets for insurance

  4. National Academy of Sciences (NAS) • MOOP = medical out of pocket expenditures • Subtract actual MOOP from income by imputing MOOP to households • No adjustments to thresholds • Retain skewed distribution by using two part model for imputation method

  5. Issues with NAS method • Assumes level of reported MOOP from survey is appropriate • Uses age, race, family size, income, insurance status in imputation model • May misclassify those who consume less than appropriate levels of health care, such as: uninsured, Hispanics, immigrants, non-working

  6. Why not add MOOP to thresholds? • Whether MOOP is subtracted from income or added to thresholds is conceptually equivalent • Major differences between 2 approaches depend on imputation method for medical care • Adding MOOP to thresholds allows a definition of reasonable levels of medical care spending

  7. Calculating Poverty Thresholds • Reference families (2A,2C) • Expenditure data for food, clothing, shelter, utilities, and medical (FSCUM) • Percent of median FSCU • Different methods of adding M • Apply equivalence scales to generate thresholds for other family types in CPS

  8. Six Measures w/ MOOP in Thresholds

  9. Medical Expenditure Panel Survey (MEPS) • About 10,000 to 15,000 households per year • Detailed information on insurance coverage, use and expenditures on all types of medical care services and supplies, family members, health status, medical conditions, employment, income, access and satisfaction • www.meps.ahrq.gov

  10. MOOP Expenditures, Reference Families, 1996 MEPS

  11. MOOP Expenditures, Uninsured Families, 1996 MEPS, no adjustment

  12. MOOP Expenditures, Uninsured Families, MEPS 1996, with adjustment

  13. Chart 1. Reference Family Annual Thresholds and MOOP Shares: 1999 Thresholds MOOP Share of Thresholds Interview quarters independent; re-estimated percentages of median

  14. Aggregate Imputed MOOP, billions $

  15. Overall Poverty Rates, 1999

  16. Poverty Rates, 1999 - Children

  17. Poverty Rates, 1999 - Elderly

  18. Poverty Rates, 1999 - Uninsured

  19. Conclusions • Poverty measurement is intended to guide public policy • Method of imputing medical care expenses does matter to policy relevant groups like the uninsured

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