(SPM) became available to HHS in fall 2011; the new measure subtracts health insurance premiums and other out-of-pocket expenses for medical care from income in determining a family’s resources for basic needs (see Short, 2011). Although this new supplemental measure will deduct medical out-of-pocket expenses from resources prior to determining poverty status, it will not adequately address the medical care economic risk to the population in terms of the adequacy of their health insurance coverage to pay for expected health care needs. The implementation of the ACA significantly increases the need for a companion measure of medical care economic risk, which would estimate the proportion of families and children who are at risk of incurring high out-of-pocket medical care expenses, including insurance premiums in relation to their income, for monitoring the effectiveness of health care reform.

The goal of the workshop was therefore to critically examine the state of the science in the development and implementation of a new measure of medical care economic risk. Such a measure needs to be feasible to implement with data that are available or likely to become available in the near future. Its purpose is to serve a monitoring function by reflecting changes in medical care economic risk that are attributable to implementation of health care reform and other factors.

Workshop participants examined

  • Concepts of medical care economic risk, examining retrospective and prospective measures of risk;
  • Issues surrounding the development of thresholds—the variability of risk across populations, including geographic variations in exposure to medical care economic risk; the vulnerability of population groups, including the insured, underinsured, and uninsured and those with chronic health conditions and acute catastrophic and noncatastrophic conditions;
  • Issues in defining resources—what is included in income in determining the ability to pay for insurance and for medical out-of-pocket expenditures, how the self-employed and different age groups pay for big expenses (assets, loans, free care); and
  • Implementation issues—data availability currently and prospectively, data quality concerns, and timeliness concerns.


The panel developed the agenda for the workshop in line with the contract charge and identified potential participants. To provide expert and detailed analysis of some of the key issues for the workshop beyond the time and resources of its members, the panel commissioned three background papers from experts in the field. The full text of these papers appears in Part III.

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