The workshop was structured to combine invited presentations and discussions among the participants on the various issues related to the development and implementation of a measure of medical care risk to inform policy that is feasible to collect and that will monitor changes in medical care economic risk over time. The workshop drew people from a wide variety of disciplines and perspectives and from federal and state agencies, the academic community, and private-sector organizations. The workshop agenda and a list of presenters appear in Appendix A. The slides used in support of the presentations are available at


This report is a summary of the presentations and the discussions flowing from the presentations during the sessions outlined in the agenda. Following this Introduction, Chapter 2 sets the context for the workshop. Chapter 3 focuses on the concept of a medical care economic risk measure, the criteria for a useful measure, and the pros and cons of retrospective and prospective measures. Chapter 4 discusses issues in the development of thresholds, tracking geographic variations in exposure to medical care economic risk, trends in financial burden of expenditures from chronic conditions, and trends in health insurance. Chapter 5 addresses issues in defining resources, starting with assessing the distribution and measurement of resources and using income and asset data from the Medical Expenditures Panel Survey, followed by presentations on how the elderly finance medical care and the financial burden of long-term care among the elderly. Chapter 6 discusses implementation issues, including availability, quality, and timeliness of data. Chapter 7 recaps the issues and next steps that may advance the current efforts from the perspective of the participants attending the workshop for developing a measure of medical care economic risk.

It is important to be specific about the nature of this report, which was prepared by the workshop rapporteur. It is a factual summary of what transpired at the workshop and is therefore limited to the views and opinions of those participating in the workshop, reflecting their concerns and areas of expertise and is confined to the material presented. The presentations and discussions were also limited by the time available for the workshop. Neither the workshop nor this summary is intended as a comprehensive review of research relative to a medical care economic risk measure, nor is it designed to generate consensus conclusions or recommendations from the participants. Workshops such as this, even though they are not designed to produce consensus recommendations and conclusions, can be very helpful in documenting what is happening in a field and providing a sense of where the field can move forward.

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