Health care expenditure burdens among elderly adults: 1987 and 1996.
OBJECTIVE
Concerns about the health care expenditure burdens of elderly adults underlie the ongoing debate over expanding Medicare benefits and strengthening Medicare+Choice. We examine burdens for this population using data from the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS).


METHODS
We estimate how frequently elderly adults live in families whose health expenditures exceed 20% or 40% of their after-tax disposable incomes. Our methodology reduces bias due to errors in income while providing an intuitive measure of exposure to the risk of high burdens.


RESULTS
Despite rapid increases in medical care prices, the percentage of elderly adults facing burdens over 20% of disposable income remained essentially constant at 20.9% in 1987 and 22.9% in 1996. The percentage with burdens exceeding 40% of disposable income was 7.3% in 1987 and 7.9% in 1996. High expenditure burdens were more prevalent among elderly adults who were poorer, older, female, higher risk, and covered only by traditional Medicare. Medicaid coverage helped to reduce burdens among the elderly poor, yet incomplete Medicaid take-up in 1996 left approximately 1.3 million elderly adults eligible for Medicaid but covered only by traditional Medicare.


CONCLUSIONS
Our results highlight the widespread prevalence of high health care expenditure burdens among elderly adults and the varying extent to which insurance coverage helped to protect them from rising health care expenditures between 1987 and 1996.
Selden
Thomas M
TM
Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA. tselden@ahrq.gov
Banthin
Jessica S
JS
D000368:Aged; D017281:Cost of Illness; D004608:Eligibility Determination; D005006:Ethnicity; D005190:Family; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data / Q000639:trends*; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends*; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data / Q000639:trends; D011203:Poverty / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States; D014505:Urban Population