accounting for some of the decline. It could also be related to a decrease in demand for medical care related to the recession.

Looking at differences in high burden levels by income, as one would expect, the percentage with high burden was much higher for people with low incomes compared with high incomes, and the gap was actually wider for people with multiple chronic conditions.

Data from the 2-year MEPS panel provides an idea of the persistence of high financial burden. These data show that people with multiple chronic conditions were more likely to have high financial burden over the 2 years. The high burden is more likely to be persistent for people with multiple chronic conditions. This is an important finding, because persistent high burden can lead to accumulated medical debt that can last for years and can have a multiplier effect on the medical cost that one faces in any given year. For example, families might be better able to absorb the costs if they have a one-time medical event that results in substantial medical costs. But if that happens again and again because of a chronic condition, that can become financially burdensome over time.

Problems Paying Medical Bills

Analysis of data from the 2007 Health Tracking Household Survey conducted at the Center for Studying Health Systems Change shows that a higher percentage of people with chronic conditions tended to report more problems paying medical bills, probably due in part to the persistence of high medical cost burdens as well as higher debt levels. A total of 29.9 percent of people with chronic conditions reported problems paying medical bills, compared with 18.5 percent of people with no chronic conditions. What is interesting to note is that higher rates of medical bill problems among persons with chronic conditions was not just the result of higher overall spending. Even people with chronic conditions who had relatively low levels of out-of-pocket spending reported more problems paying medical bills, compared with people with no chronic conditions who reported similarly low levels of spending.

Conclusion

Cunningham concluded that these findings suggest that there is something fundamentally different about having chronic conditions, which should be taken into account when setting affordability thresholds. There is evidence that people with chronic conditions do have lower affordability thresholds than other people. That is especially the case for people with multiple chronic conditions. At similar levels of out-of-pocket spending relative to income, people with chronic conditions reported more problems



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