title: Health Spending For Low-, Middle-, And High-Income Americans, 1963-2012.
abstract: US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles. We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012. Before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures, despite their worse health compared to other income groups. By 1977 the unadjusted expenditures for the lowest quintile exceeded those for all other income groups. This pattern persisted until 2004. Thereafter, expenditures fell for the lowest quintile, while rising more than 10 percent for the middle three quintiles and close to 20 percent for the highest income quintile, which had the highest expenditures in 2012. The post-2004 divergence of expenditure trends for the wealthy, middle class, and poor occurred only among the nonelderly. We conclude that the new pattern of spending post-2004, with the wealthiest quintile having the highest expenditures for health care, suggests that a redistribution of care toward wealthier Americans accompanied the health spending slowdown.
authors.affiliation: Samuel L. Dickman (samuel.dickman@ucsf.edu) was a student at Harvard Medical School, in Boston, Massachusetts, at the time this work was carried out. He is currently a medical intern at the University of California, San Francisco.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Dickman
authors.affiliation: Steffie Woolhandler is a professor of health policy at Hunter College, City University of New York, in New York City, and a lecturer in medicine at Harvard Medical School.
authors.forename: Steffie
authors.initials: S
authors.lastname: Woolhandler
authors.affiliation: Jacob Bor is an assistant professor in the Departments of Global Health and Epidemiology at the Boston University School of Public Health, in Massachusetts.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bor
authors.affiliation: Danny McCormick is an associate professor of medicine at Harvard Medical School and chief of the Division of Social and Community Medicine in the Department of Medicine at the Cambridge Health Alliance, in Cambridge, Massachusetts.
authors.forename: Danny
authors.initials: D
authors.lastname: McCormick
authors.affiliation: David H. Bor is an associate professor of medicine at Harvard Medical School and chief of the Department of Medicine at the Cambridge Health Alliance.
authors.forename: David H
authors.initials: DH
authors.lastname: Bor
authors.affiliation: David U. Himmelstein is a professor of health policy at Hunter College, City University of New York, and a lecturer in medicine at Harvard Medical School.
authors.forename: David U
authors.initials: DU
authors.lastname: Himmelstein
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data; D005260:Female; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D007182:Income / Q000639:trends; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011203:Poverty / Q000706:statistics & numerical data; D012737:Sex Factors; D012923:Social Class; D014481:United States
keywords: Disparities; Health Economics; Health Spending; Inequality