Private Insurance May Fail to Protect Against Healthcare Financial Hardship, Evidence from the 2018 and 2019 Medical Expenditure Panel Survey
Author(s)
Yizhi Liang, MBBS, MS1, Boshen Jiao, MPH, PhD2;
1University of Southern California, Department of Pharmaceutical and Health Economics, School of Pharmacy, Log Angeles, CA, USA, 2University of Southern California, Department of Pharmaceutical and Health Economics, School of Pharmacy, Los Angeles, CA, USA
1University of Southern California, Department of Pharmaceutical and Health Economics, School of Pharmacy, Log Angeles, CA, USA, 2University of Southern California, Department of Pharmaceutical and Health Economics, School of Pharmacy, Los Angeles, CA, USA
Presentation Documents
OBJECTIVES: Chronic diseases often place significant financial burdens on families due to out-of-pocket (OOP) costs. While it is well established that uninsured individuals are particularly vulnerable to financial hardship, it remains unclear whether private health insurance, designed to protect against such risks, effectively fulfills this purpose. This study examines whether chronic diseases are linked to additional financial risks and assesses how private health insurance alleviates these risks.
METHODS: Using data from the 2018 and 2019 Medical Expenditure Panel Survey, we analyzed individuals aged 19 to 64 to examine healthcare financial hardship at the family level, categorized into three dimensions: (1) high OOP burden (OOP spending exceeding 10% of family income); (2) medical debt; and (3) barriers to care (forgone or delayed healthcare due to cost). The analysis focused on chronic conditions associated with potentially high medical expenses, including cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, cancer, arthritis, and asthma. Condition-specific regression models were used to estimate the incremental probability of experiencing financial hardship, stratified by insurance type and income, adjusting for socioeconomic status and comorbidities.
RESULTS: As expected, uninsured individuals faced elevated levels of financial hardship associated with chronic conditions. However, notable additional financial burdens were also observed among privately insured individuals. All chronic conditions were associated with a higher probability of financial hardship. COPD had the most considerable impact, increasing the probability of financial hardship by 9.8% (95% CI 5.1%, 14.9%). The second was arthritis, increasing the probability of financial hardship by 8.4% (95% CI 6.2%, 11.0%). While poor families were most affected, financial hardships persisted across income levels.
CONCLUSIONS: Efforts to reduce healthcare financial hardship must go beyond expanding insurance coverage for uninsured populations. Policymakers should prioritize expanding insurance coverage and enhance the adequacy and comprehensiveness of existing private insurance plans to address the persistent gaps in financial protection.
METHODS: Using data from the 2018 and 2019 Medical Expenditure Panel Survey, we analyzed individuals aged 19 to 64 to examine healthcare financial hardship at the family level, categorized into three dimensions: (1) high OOP burden (OOP spending exceeding 10% of family income); (2) medical debt; and (3) barriers to care (forgone or delayed healthcare due to cost). The analysis focused on chronic conditions associated with potentially high medical expenses, including cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, cancer, arthritis, and asthma. Condition-specific regression models were used to estimate the incremental probability of experiencing financial hardship, stratified by insurance type and income, adjusting for socioeconomic status and comorbidities.
RESULTS: As expected, uninsured individuals faced elevated levels of financial hardship associated with chronic conditions. However, notable additional financial burdens were also observed among privately insured individuals. All chronic conditions were associated with a higher probability of financial hardship. COPD had the most considerable impact, increasing the probability of financial hardship by 9.8% (95% CI 5.1%, 14.9%). The second was arthritis, increasing the probability of financial hardship by 8.4% (95% CI 6.2%, 11.0%). While poor families were most affected, financial hardships persisted across income levels.
CONCLUSIONS: Efforts to reduce healthcare financial hardship must go beyond expanding insurance coverage for uninsured populations. Policymakers should prioritize expanding insurance coverage and enhance the adequacy and comprehensiveness of existing private insurance plans to address the persistent gaps in financial protection.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR170
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Insurance Systems & National Health Care
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), SDC: Oncology, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)