Health Care Costs and Financing

Expansion in public health insurance for children lessens the financial burden of health care for low-income families

Expansions in public health insurance programs between 1980 and 2000 have reduced the financial burden of out-of-pocket medical expenses for children in poor families, concludes a study supported by the Agency for Healthcare Research and Quality (HS11662). Federal and State Medicaid health insurance programs expanded the number of families eligible for Medicaid coverage throughout the 1980's and 1990's. Also, in 1997, the State Children's Health Insurance Programs (SCHIP) were enacted and included children of families who were not poor enough to qualify for Medicaid. Both programs limit deductibles, coinsurance, and copayments to nominal levels, note the study authors. As a result, there was a large increase in the proportion of children in low-income families covered by public insurance between 1980 and 2000.

The researchers compared patterns of out-of-pocket health care expenditures and their associated financial burden for children aged 0 to 18 years in 6 poverty level groups (family income ranging from 100 to 300 percent of the poverty threshold and above). The 2000 poverty threshold was $17,050 for a family of four. The researchers used the same poverty thresholds to analyze data from the 1980 National Medical Care Utilization and Expenditure Survey and the 2000 Medical Expenditure Panel Survey.

In 2000, total out-of-pocket health care expenditures for children averaged $200 per child. Relative financial burden (out-of-pocket expenses relative to family income) decreased significantly for all of the impoverished groups studied in 2000 compared to 1980. They ranged from a reduction of 36.5 percent for those below 100 percent of the Federal poverty level, to a reduction of 46.7 percent for those at or above 300 percent (4 times) the Federal poverty level. Despite these persistent socioeconomic disparities in financial burden, low-income children with public insurance had a 49.5 percent lower relative financial burden than similar children without insurance, while those with private insurance had a 79 percent greater relative financial burden.

See "Disparities in the financial burden of children's healthcare expenditures," by Sabrina T. Wong, R.N., Ph.D., Alison Galbraith, M.D., M.P.H., Sue Kim, Ph.D., M.P.H., and Paul W. Newacheck, Dr.P.H., in the November 2005 Archives of Pediatric and Adolescent Medicine 159, pp. 1008-1013.

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