Out-of-pocket health expenses for Medicaid and other poor and near-poor persons in 1980

Abstract

The Medicaid program (Title XIX of the Social Security Act) was designed to provide access to health services at little or no out-of-pocket expense to low-income persons who might otherwise not be able to afford them. Information was collected through household interviews in the National Medical Care Utilization and Expenditure Survey (NMCUES) on total out-of-pocket expenditures for health care by noninstitutionalized persons in the United States in 1980. This report presents data to assess the degree to which Medicaid enrollees incur out-of-pocket expenses. These levels of expenditures are compared to those experienced by other persons not eligible for Medicaid who are below or near the official poverty level. Data contained in this report were derived from the National Household Survey (HHS), a panel survey of 6,600 households representative of the civilian, noninstitutionalized U.S. population, which is only one of the three surveys that were conducted as part of NMCUES. The other two surveys are a State Medicaid Household Survey (SMHS) of Medicaid households in four States and the Administrative Records Survey (ARS), a survey of existing Medicare and Medicaid administrative records for sample households. Since data were derived only from HHS, the findings in this report are national (or regional) in scope and cannot be tied directly to differences in individual State Medicaid programs. The data on eligibility and expenditures are all self-reported and have not been verified by administrative records. One definite limitation of these data is the exclusion from the NMCUES sample of all institutionalized persons. As a result, out-of-pocket expenses for one particularly high-cost group are excluded, and total out-of-pocket expenditures for each health insurance coverage group are understated. Another potential limitation of this analysis is that, as with many surveys, limited data on key items (such as out-of-pocket expenses and income) were at times missing from respondent reports. These missing data were imputed according to standard statistical techniques (see Appendix III). A variety of findings is presented, including data on the effect of health insurance coverage, demographic characteristics, health status, and continuity of Medicaid enrollment on out-of-pocket expenses. Within insurance coverage categories, Medicaid-covered persons had the lowest out-of-pocket expenses. This was true even though they had the highest mean per capita charges for care. Among the demographic characteristics that were analyzed, age and race had the most impact on the level of out-of-pocket health expenses.(ABSTRACT TRUNCATED AT 400 WORDS)