JAMA internal medicine · 2026
Risk of Burdensome Health Care Spending Over Time in the US.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Gaffney Adam, McCormick Danny, Dickman Samuel L, Bor David, Azaroff Lenore, Himmelstein David U, Woolhandler Steffie
Аннотация
IMPORTANCE: Cross-sectional studies indicate that out-of-pocket (OOP) health care costs strain household finances, but few studies have examined the risk of incurring burdensome health care spending longitudinally among individuals in the US.
OBJECTIVE: To assess burdensome OOP health care costs (and care foregone due to cost) over a 4-year period.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, data were analyzed on respondents to the 4-year longitudinal Medical Expenditure Panel Surveys (MEPS), a nationally representative household survey of the US noninstitutionalized population conducted from 2018 to 2022. Analyses were performed from November 2024 to October 2025.
MAIN OUTCOMES AND MEASURES: Primary outcomes included 4 cost-related outcomes: cost burden, defined as individual annual OOP medical spending greater than 10% of family income (>5% for low-income individuals); catastrophic cost burden (CCB) defined as OOP spending greater than 40% of postsubsistence income; foregone care due to cost; and family-level cost burden. Risk was assessed using time-to-event analyses, overall and among subgroups, eg, baseline chronic disease, hospitalization, and uninsurance, and death during the study period.
RESULTS: Among 12 645 MEPS respondents, 74.6% (95% CI, 73.4%-75.8%) were aged 18 years or older and 50.6% (95% CI, 49.7%-51.6%) were female individuals (weighted); among adults, 50.3% (95% CI, 48.6%-52.0%) had a chronic disease, 7.9% (95% CI, 7.2%-8.7%) were hospitalized, and 2.3% (95% CI, 2.0%-2.6%) died. During year 1, 6.5% of adults experienced cost burdens (and 3.5% CCB); 17.4% (and 9.9% CCB) experienced these outcomes (respectively) at least once over 4 years. Overall, 24.7% of US individuals lived in families experiencing cost burdens over 4 years, and 11.2% lived in families experiencing CCBs. Overall, 26.7% of adults experienced either foregone care due to cost or cost burden over 4 years. Lower income, having no insurance, hospitalizations, and chronic disease were each associated with higher cost burden. Overall, 53.2% of decedents experienced cost burdens in 1 to 4 years before death.
CONCLUSIONS AND RELEVANCE: This cohort study found that the US health care system imposes cost burdens on a larger share of the population than suggested by cross-sectional analyses, and most individuals in the US will experience such burdens during their lifetimes. Policies that reduce OOP costs might improve the well-being of individuals in the US.
OBJECTIVE: To assess burdensome OOP health care costs (and care foregone due to cost) over a 4-year period.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, data were analyzed on respondents to the 4-year longitudinal Medical Expenditure Panel Surveys (MEPS), a nationally representative household survey of the US noninstitutionalized population conducted from 2018 to 2022. Analyses were performed from November 2024 to October 2025.
MAIN OUTCOMES AND MEASURES: Primary outcomes included 4 cost-related outcomes: cost burden, defined as individual annual OOP medical spending greater than 10% of family income (>5% for low-income individuals); catastrophic cost burden (CCB) defined as OOP spending greater than 40% of postsubsistence income; foregone care due to cost; and family-level cost burden. Risk was assessed using time-to-event analyses, overall and among subgroups, eg, baseline chronic disease, hospitalization, and uninsurance, and death during the study period.
RESULTS: Among 12 645 MEPS respondents, 74.6% (95% CI, 73.4%-75.8%) were aged 18 years or older and 50.6% (95% CI, 49.7%-51.6%) were female individuals (weighted); among adults, 50.3% (95% CI, 48.6%-52.0%) had a chronic disease, 7.9% (95% CI, 7.2%-8.7%) were hospitalized, and 2.3% (95% CI, 2.0%-2.6%) died. During year 1, 6.5% of adults experienced cost burdens (and 3.5% CCB); 17.4% (and 9.9% CCB) experienced these outcomes (respectively) at least once over 4 years. Overall, 24.7% of US individuals lived in families experiencing cost burdens over 4 years, and 11.2% lived in families experiencing CCBs. Overall, 26.7% of adults experienced either foregone care due to cost or cost burden over 4 years. Lower income, having no insurance, hospitalizations, and chronic disease were each associated with higher cost burden. Overall, 53.2% of decedents experienced cost burdens in 1 to 4 years before death.
CONCLUSIONS AND RELEVANCE: This cohort study found that the US health care system imposes cost burdens on a larger share of the population than suggested by cross-sectional analyses, and most individuals in the US will experience such burdens during their lifetimes. Policies that reduce OOP costs might improve the well-being of individuals in the US.