26 Apr Family and Individuals Directly Pay Less Than 14% of US Health Care Expenditures
MedicalResearch.com Interview with:
Marie Stagnitti, M.P.A.
Agency for Healthcare Research and Quality
Medical Expenditure Panel Survey Household Component Project Officer/Senior Survey Statistician
MedicalResearch.com: What is the background for this study?
Response: The Medical Expenditure Panel Survey (MEPS) – Household Component (HC) which began in 1996 and is administered annually collects data from a sample of families and individuals in selected communities across the United States, and is drawn from a nationally representative subsample of households that participated in the prior year’s National Health Interview Survey (conducted by the National Center for Health Statistics).
During the household interviews, MEPS collects detailed information for each person in the household on the following: demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment.
The panel design of the survey, which features several rounds of interviews covering two full calendar years, makes it possible to determine how changes in respondents’ health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related.
MedicalResearch.com: What are the main findings?
Response: Hospital inpatient expenses accounted for nearly 30 percent of total health care expenses for the U.S. civilian noninstitutionalized population, and prescribed medicines accounted for more than 20 percent.
Among persons under age 65, the uninsured and those with any private insurance had a larger proportion of their health care spending accounted for by ambulatory services (office-based visits, hospital outpatient care, and emergency room care) than those with public insurance only.
Among the elderly, those with Medicare and private insurance had a larger proportion of their health care spending accounted for by ambulatory services than those with Medicare only or Medicare and other public insurance.
Health care expenses are paid largely by third-party payers. In 2013, private insurance paid for 40.6 percent of total expenses, Medicare paid for 25.3 percent, individuals and family members paid for 13.8 percent, Medicaid/CHIP paid for 12.4 percent, and other sources paid for 7.9 percent.
MedicalResearch.com: What should readers take away from your report?
Response: The United States spends a larger share of its Gross Domestic Product on health care than any other major industrialized country. To address high health care costs in this country, policymakers need to understand how those costs are distributed across types of services, different payers and by various characteristics of the population. This Statistical Brief presents critical estimates showing distributions of health care spending by type of service and distributions by payment sources within age and insurance groups in 2013.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Understanding how healthcare costs are distributed by type of service and payment source are critical to understanding how health care is used and paid for currently and how it changes over time. The annual fielding of the MEPS-HC allows for changes in these distributions to be tracked currently and over time, and is critical making informed decisions on health care policy.
MedicalResearch.com: Is there anything else you would like to add?
Response: Expense estimates include payments made by individuals, private insurance, Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), and other payment sources, and include total direct payments from these sources to hospitals, physicians, home health providers (agency and paid independent providers), dental providers, other types of health care providers (e.g. physical therapists, chiropractors, optometrists etc.) and pharmacies for services reported by respondents in the MEPS-HC. Expenses for hospital-based services include those for both facility and separately billed physician services.
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