impute such variables as taxes, commuting, and child care expenses. These components could be imputed to MEPS or added to the MEPS questionnaire in the future.

Although the panel favors a prospective measure of MCER over a retrospective measure, the more substantial data requirements of the prospective measure cannot be fully met with an existing survey. The MEPS longitudinal file comes closest to meeting these requirements, with the HRS providing a means to validate the results of MEPS modeling for older people.

Recommendation 5-1: The panel recommends that the development of a model for estimating a prospective measure of medical care economic risk be carried out with the Medical Expenditure Panel Survey (MEPS) longitudinal file. The panel also recommends that the Health and Retirement Study (HRS) be used to validate the results of the MEPS modeling for at least the elderly, if not the entire population over age 50, which the HRS sample represents.

Recommendation 5-2: The panel recommends that the Census Bureau and the Agency for Healthcare Research and Quality assess the merits of adding items to both the Current Population Survey Annual Social and Economic Supplement and the Medical Expenditure Panel Survey to at least partially address the most critical data limitations identified for measuring medical care economic risk.

Implementing Measures of MCER and Burden

Throughout its review and deliberations, the panel has aimed to develop rigorous yet practical approaches to defining and measuring the financial burden and risk associated with out-of-pocket medical care costs. Specifically, we focused on how exposure to medical care expenses can threaten families and individuals with being driven into poverty. Through commissioned papers, workshop presentations and discussions, and deliberations, we sought to bring to bear the latest research and data. We have also kept in mind what actually can be done by government agencies without major infusions of additional staff or funding.

For the introduction of a measure of MCER to be successful, clear lines of responsibility for its implementation must be established. The two federal agencies with the greatest expertise in the development and implementation of such a measure are the U.S. Department of Health and Human Services and the U.S. Department of Commerce. The panel thinks that a subcabinet-level coordinating group would help to ensure that a measure of MCER moves forward in its development and launch. This



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