THE DIFFERENTIAL IMPACT OF FAMILY-LEVEL MULTIMORBIDITY ON FINANCIAL HARDSHIP BY INSURANCE STATUS EVIDENCE FROM MEPS 2018-2023
Author(s)
Yizhi Liang, BS, MS1, Boshen Jiao, MPH, PhD2;
1School of Pharmacy, University of Southern California, Department of Pharmaceutical and Health Economics, Log Angeles, CA, USA, 2School of Pharmacy, University of Southern California, Department of Pharmaceutical and Health Economics, Los Angeles, CA, USA
1School of Pharmacy, University of Southern California, Department of Pharmaceutical and Health Economics, Log Angeles, CA, USA, 2School of Pharmacy, University of Southern California, Department of Pharmaceutical and Health Economics, Los Angeles, CA, USA
OBJECTIVES: The financial toxicity of chronic disease remains a critical concern in the U.S. healthcare system. This study estimates the marginal effect of family-level chronic disease burden on financial hardship, specifically analyzing heterogeneity across private, public, and uninsured coverage to determine how well different insurance structures protect families with multimorbidity.
METHODS: We analyzed data from the 2018-2023 Medical Expenditure Panel Survey (MEPS). The primary exposure was the count of priority chronic conditions per family (0, 1-2, 3+). Outcomes included high out-of-pocket (OOP) burden (defined as OOP spending exceeding 40% of family income), medical debt, cost-related barriers to care, and a composite indicator of any financial problem. We estimated marginal effects using survey-weighted probability models adjusted for family size, income, region, and demographic characteristics (e.g., age, race and ethnicity, disability burden), including year and panel fixed effects.
RESULTS: Relative to families with no chronic conditions, multimorbidity (3+ conditions) significantly increased the probability of financial hardship across all insurance types, though the magnitude varied substantially. Privately insured families exhibited a significant positive gradient between disease count and financial strain, particularly regarding medical debt and high OOP burden. Conversely, public insurance demonstrated a strong protective effect against catastrophic spending; the marginal increase in high OOP burden for publicly insured families with 3+ conditions was statistically negligible compared to the baseline. However, publicly insured families continued to face significant cost-related barriers to care. Uninsured families faced the most severe economic vulnerability, with a baseline prevalence of “any financial problem” at 52.4% and the steepest marginal risk increases associated with additional conditions.
CONCLUSIONS: While public insurance successfully insulates families from the catastrophic OOP costs associated with multimorbidity more effectively than private plans, barriers to care persist. These findings suggest that while coverage type moderates financial risk, current private insurance structures may inadequately protect chronically ill families from debt accumulation.
METHODS: We analyzed data from the 2018-2023 Medical Expenditure Panel Survey (MEPS). The primary exposure was the count of priority chronic conditions per family (0, 1-2, 3+). Outcomes included high out-of-pocket (OOP) burden (defined as OOP spending exceeding 40% of family income), medical debt, cost-related barriers to care, and a composite indicator of any financial problem. We estimated marginal effects using survey-weighted probability models adjusted for family size, income, region, and demographic characteristics (e.g., age, race and ethnicity, disability burden), including year and panel fixed effects.
RESULTS: Relative to families with no chronic conditions, multimorbidity (3+ conditions) significantly increased the probability of financial hardship across all insurance types, though the magnitude varied substantially. Privately insured families exhibited a significant positive gradient between disease count and financial strain, particularly regarding medical debt and high OOP burden. Conversely, public insurance demonstrated a strong protective effect against catastrophic spending; the marginal increase in high OOP burden for publicly insured families with 3+ conditions was statistically negligible compared to the baseline. However, publicly insured families continued to face significant cost-related barriers to care. Uninsured families faced the most severe economic vulnerability, with a baseline prevalence of “any financial problem” at 52.4% and the steepest marginal risk increases associated with additional conditions.
CONCLUSIONS: While public insurance successfully insulates families from the catastrophic OOP costs associated with multimorbidity more effectively than private plans, barriers to care persist. These findings suggest that while coverage type moderates financial risk, current private insurance structures may inadequately protect chronically ill families from debt accumulation.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR68
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas