title: Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy.
abstract: BACKGROUND
  Evaluating the adequacy of Medicare prescription drug program (Part D) and its low-income subsidy (LIS) requires a comprehensive understanding of drug spending in relation to household resources.
  
  
  OBJECTIVE
  : To estimate out-of-pocket health care costs in the year before Part D, in context of total household spending, health status, and LIS eligibility.
  
  
  METHODS
  Nationally representative cross-sectional study.
  
  
  METHODS
  Two thousand two hundred thirty-one Medicare families in the 2005/2006 Health and Retirement Study.
  
  
  METHODS
  We assessed health care costs as a share of household resources remaining after spending on essential housing, food, personal care, and transportation. Burdensome health care costs were defined as exceeding 40% of nonessential resources. We used logistic regressions to assess the probability of incurring burdensome health expenditures, controlling for LIS eligibility.
  
  
  RESULTS
  In the year before Part D, more than half of Medicare families [56.0%; 95% confidence interval (CI): 55.3-59.9] experienced burdensome health care costs. Families in poor health allocated a median of 68.1% [interquartile range (IQR): 35.1-82.9] of nonessential resources to health care (compared with 34.0% median; IQR 11.9-52.2 among families in excellent health, P < 0.011). Most (64%) out-of-pocket health care spending was allocated to health insurance premiums and medications. As many as 26% of Medicare families had burdensome health care costs but were not eligible for LIS assistance.
  
  
  CONCLUSIONS
  Before Part D, burdensome health care expenditures were common in Medicare families. Our estimates of Part D and LIS benefits indicate a limited scope of relief.
authors.affiliation: Division of Geriatric Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, 377 Plantation Street, Worcester, MA 01605, USA. Becky.Briesacher@umassmed.edu.
authors.forename: Becky A
authors.initials: BA
authors.lastname: Briesacher
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Anita K
authors.initials: AK
authors.lastname: Wagner
authors.forename: Hassan
authors.initials: H
authors.lastname: Fouayzi
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D017281:Cost of Illness; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000191:economics*; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006801:Humans; D007182:Income; D008297:Male; D054524:Medicare Part D / Q000191:economics*; D008875:Middle Aged; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
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