to the new Supplemental Poverty Measure. The workshop will examine retrospective and prospective measures of medical care risk, defined as the risk of incurring high out-of-pocket medical care expenses (including insurance premiums) relative to income … and other related issues. Based on the workshop and its deliberations, the panel will prepare a report with findings and recommendations that will help the field to move forward to implement a new measure of medical care risk that will be valuable for monitoring the implementation of health care reform. The report will include a summary of the workshop and commissioned papers.

In response to this request, the National Research Council’s (NRC’s) Committee on National Statistics, in collaboration with the Board on Health Care Services of the Institute of Medicine, appointed a nine-member panel representing a range of expertise related to the scope of the study. The panel executed its charge through the conduct of a workshop, commissioning background papers, holding panel meetings, and reviewing research and other reports. The goal of the panel was to move forward toward developing measures to inform policy that are feasible to collect and estimate and that will monitor changes in medical care economic risk and burden as health care reform is implemented and other relevant public- and private-sector changes occur.

On the basis of the workshop discussions and its own review and deliberations of the issues, the panel developed conclusions and recommendations in five areas: (1) concepts of medical care economic burden and risk, (2) concepts of resources, (3) measurement of medical care economic risk, (4) data sources, and (5) development and implementation of the panel’s proposed measures. Recommendations in this summary are numbered by the chapter in which they appear in the body of the report.


Concepts of Burden and Risk

There is a conceptual difference between medical care economic burden and risk, and the panel thinks that measures of both are needed to inform national and state policy and to assess economic trends. Burden is a retrospective measure that examines actual out-of-pocket spending for health insurance and medical care relative to a family’s available resources. Risk is a prospective measure that assesses the likelihood that a family’s future out-of-pocket medical care expenditures would be high or unaffordable relative to the family’s resources.

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