MEDICAL CARE ECONOMIC RISK
Measuring Financial Vulnerability
from Spending on Medical Care
Panel on Measuring Medical Care Risk in Conjunction with
the New Supplemental Income Poverty Measure
Michael J. O’Grady and Gooloo S. Wunderlich, Editors
Committee on National Statistics
Division of Behavioral and Social Sciences and Education
Board on Health Care Services
Institute of Medicine
NATIONAL RESEARCH COUNCIL AND
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract/Grant No. HHSP23320042509XI, TO#39 between the National Academy of Sciences and the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. Support for the work of the Committee on National Statistics is provided by a consortium of federal agencies through a grant from the National Science Foundation (award number SES-1024012). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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Copyright 2012 by the National Academy of Sciences. All rights reserved.
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Suggested citation: National Research Council and Institute of Medicine. (2012). Medical Care Economic Risk: Measuring Financial Vulnerability from Spending on Medical Care. Panel on Measuring Medical Care Risk in Conjunction with the New Supplemental Income Poverty Measure, M.J. O’Grady and G.S. Wunderlich, Eds. Committee on National Statistics, Division of Behavioral and Social Sciences and Education, and Board on Health Care Services, Institute of Medicine. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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PANEL ON MEASURING MEDICAL CARE RISK IN CONJUNCTION WITH THE NEW SUPPLEMENTAL INCOME POVERTY MEASURE
MICHAEL J. O’GRADY (Chair), President, West Health Policy Center
DAVID M. BETSON, Department of Economics, University of Notre Dame
JOHN L. CZAJKA, Mathematica Policy Research, Inc., Washington, DC
EDWIN C. HUSTEAD, Actuary (retired), Alexandria, VA
EMMETT B. KEELER, Pardee RAND Graduate School, School of Public Health, University of California, Los Angeles
WILLARD G. MANNING, Harris School of Public Policy Studies, University of Chicago
WILHELMINE D. MILLER, NORC at the University of Chicago
CATHY SCHOEN, The Commonwealth Fund, New York, NY
P.J. ERIC STALLARD, Social Science Research Institute, Duke University
GOOLOO S. WUNDERLICH, Study Director
JACQUELINE R. SOVDE, Program Associate
JESSICA BANTHIN, Consultant
COMMITTEE ON NATIONAL STATISTICS 2011-2012
LAWRENCE D. BROWN (Chair), Department of Statistics, Wharton School, University of Pennsylvania
JOHN M. ABOWD, School of Industrial and Labor Relations, Cornell University
ALICIA CARRIQUIRY, Department of Statistics, Iowa State University
WILLIAM DUMOUCHEL, Oracle Health Sciences, Waltham, MA
V. JOSEPH HOTZ, Department of Economics, Duke University
MICHAEL HOUT, Survey Research Center, University of California, Berkeley
KAREN KAFADAR, Department of Statistics, Indiana University
SALLIE KELLER, Provost, University of Waterloo, Ontario, Canada
LISA LYNCH, Heller School for Social Policy Management, Brandeis University
SALLY C. MORTON, Biostatistics Department, Graduate School of Public Health, University of Pittsburgh
JOSEPH NEWHOUSE, Division of Health Policy Research and Education, Harvard University
RUTH PETERSON, Department of Sociology (emeritus) and Criminal Justice Research Center, Ohio State University
HAL STERN, Donald Bren School of Information and Computer Sciences, University of California, Irvine
JOHN THOMPSON, NORC at the University of Chicago
ROGER TOURANGEAU, Westat, Rockville, MD
ALAN ZASLAVSKY, Department of Health Care Policy, Harvard Medical School
CONSTANCE F. CITRO, Director
BOARD ON HEALTH CARE SERVICES
STEVEN A. SCHROEDER (Chair), Department of Medicine, University of California, San Francisco
JOSEPH R. BAKER, Medicare Rights Center, New York
ELISABETH BELMONT, Mainehealth, Portland, ME
ROBERT A. BERENSON, The Urban Institute, Washington, DC
LISA A. BERO, School of Medicine, University of California, San Francisco
DAVID BLUMENTHAL, Harvard Medical School and Mongan Institute for Health Policy, Massachusetts General Hospital
STUART BUTLER, Center for Policy Innovation, Heritage Foundation
JON B. CHRISTIANSON, School of Public Health, University of Minnesota
JACK EBELER, Health Policy Alternatives, Inc., Washington, DC
ROBERT S. GALVIN, Equity Healthcare and Corporate Private Equity, Blackstone Group, New York
REBEKAH E. GEE, Schools of Medicine and Public Health, Louisiana State University
CARMEN R. GREEN, Schools of Medicine and Public Health, University of Michigan Health System
MAREASA R. ISAACS, National Alliance of Multi-Ethnic Behavioral Health Associations, Silver Spring, MD
DBRENT C. JAMES, Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, UT
CHARLES N. KAHN, III, Federation of American Hospitals, Washington, DC
ELIZABETH A. McGLYNN, Kaiser Permanente Center for Effectiveness and Safety Research, Oakland, CA
CYNTHIA D. MULROW, University of Texas Health Science Center, San Antonio
MARY D. NAYLOR, New Courtland Center for Transitions and Health and Interdisciplinary Nursing Quality Research Initiative, University of Pennsylvania
ALAN WEIL, National Academy for State Health Policy, Washington, DC
GAIL R. WILENSKY, Project HOPE, Bethesda, MD
ROGER HERDMAN, Board Director
The Panel on Measuring Medical Care Risk in Conjunction with the New Supplemental Income Poverty Measure acknowledges with appreciation the contributions of the many individuals who gave of their time and knowledge to this report.
Support for the study was provided by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Donald Oellerich, project officer for the study, was very helpful in providing relevant information and presenting at a workshop organized by the panel. In addition, David S. Johnson of the U.S. Census Bureau provided invaluable insights into the Census Bureau’s work on the measurement of poverty and its relationship with medical care out-of-pocket expenditures.
We acknowledge with appreciation the many people who participated in a workshop convened by the panel and contributed to its success. We thank all the presenters for their expert presentations and the participants for their stimulating and insightful comments and discussion. A summary of the workshop is in Part II of the report.
We are grateful to Jessica Banthin, Didem Bernard, John Czajka, Sarah Meier, and Barbara Wolfe, the authors of commissioned papers prepared for the study. These papers were used by panel and staff in drafting the report and are included in Part III of the report.
Members of the panel gave generously of their time and expert knowledge in the deliberations that produced this report. Their timely and thoughtful work in drafting written reviews of various issues in the report is gratefully acknowledged.
Staff of the Committee on National Statistics (CNSTAT) and the Division of Behavioral and Social Sciences and Education (DBASSE) provided important support and assistance to the panel. Gooloo S. Wunderlich, study director, was responsible for organizing the workshop and the meetings of the panel, preparing the summary of the workshop presentations and discussions, getting the background papers commissioned, drafting large portions of the report based on the reviews prepared by the panel members, and responding to the many comments from the reviewers on behalf of the panel. Jacqui Sovde provided administrative support. We gratefully acknowledge the important role of Constance F. Citro, director of CNSTAT, for providing guidance and support throughout the study and in the preparation of this report. Christine McShane, DBASSE senior editor, provided editing advice, and Alisa Decatur provided advice on references. Yvonne Wise, DBASSE production editor, processed the report through the final production, and Kirsten Sampson-Snyder, DBASSE senior report review officer, efficiently shepherded the report through the report review process.
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council (NRC). The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report: Greg J. Duncan, Department of Education, University of California, Irvine; Jonathan H. Gruber, Department of Economics, Massachusetts Institute of Technology; Gerald F. Kominsky, Department of Health Services, University of California, Los Angeles, Fielding School of Public Health; Charles E. Phelps, University Professor and Provost Emeritus, University of Rochester; Timothy M. Smeeding, Institute for Research on Poverty, Robert M. LaFollette School of Public Affairs, University of Wisconsin–Madison; Laura Wheaton, Income and Benefits Policy Center, The Urban Institute; Gary J. Young, Center for Health Policy and Health Care Research, Northeastern University; Alan M. Zaslavsky, Department of Health Care Policy, Harvard Medical School; and Julie Zissimopoulos, Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California.
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the report nor did they see the final draft of the report before its release. The review of this report was overseen by Melvin Worth, senior Institute
of Medicine fellow (retired), Sun City Center, Florida (coordinator), and Jonathan S. Skinner, Economics Department and the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College (monitor). Appointed by the NRC, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring panel and the institution.
Michael J. O’Grady, Chair
Panel on Measuring Medical Care Risk in Conjunction with the New Supplemental Income Poverty Measure