title: Out-of-pocket health spending between low-and higher-income populations: who is at risk of having high expenses and high burdens?
abstract: OBJECTIVE
  We studied the effects of health insurance, health care needs, and demographic and area characteristics on out-of-pocket health care spending for low and higher income insured populations.
  
  
  METHODS
  We used the 2002 National Survey of America's Families to analyze out-of-pocket health spending. People were classified into 3 levels of expenses based on their out-of-pocket health care spending and 3 levels of financial burden based on spending as a share of family income. We used a multinomial logit model to estimate the effect of insurance status and other factors on expense and burden levels.
  
  
  RESULTS
  Public insurance appears to offer the best financial protection from high out-of-pocket expenses and financial burden for those who are eligible. Families with private nongroup coverage have the highest odds of being in the high-expense and high-burden categories for all incomes. For higher-income families, having a family member in fair or poor health is a significant risk factor for high out-of-pocket expenses and financial burden. Having higher penetration of health maintenance organizations in an area appears to lower the odds of being in the high-burden category for all families.
  
  
  CONCLUSIONS
  Health insurance may not prevent people from having high health care spending. Low-income people with serious health needs appear to be financially constrained and spend less on health care relative to higher-income people, and the presence of health maintenance organizations may help reduce out-of-pocket health care spending.
authors.affiliation: National Bureau of Economic Research and Naval Postgraduate School, Monterey, CA 93943, USA. yshen@nps.edu
authors.forename: Yu-Chu
authors.initials: YC
authors.lastname: Shen
authors.forename: Joshua
authors.initials: J
authors.lastname: McFeeters
mesh_terms: D017281:Cost of Illness; D003625:Data Collection; D003710:Demography; D005382:Financing, Personal / Q000191:economics*; D005102:Health Expenditures; D006301:Health Services Needs and Demand; D006801:Humans; D018570:Risk Assessment; D012923:Social Class; D014481:United States