@article {7455, title = {Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Jun}, pages = {503-9}, publisher = {48}, abstract = {

BACKGROUND: Evaluating the adequacy of Medicare prescription drug program (Part D) and its low-income subsidy (LIS) requires a comprehensive understanding of drug spending in relation to household resources.

OBJECTIVE: : To estimate out-of-pocket health care costs in the year before Part D, in context of total household spending, health status, and LIS eligibility.

RESEARCH DESIGN: Nationally representative cross-sectional study.

SUBJECTS: Two thousand two hundred thirty-one Medicare families in the 2005/2006 Health and Retirement Study.

METHODS: We assessed health care costs as a share of household resources remaining after spending on essential housing, food, personal care, and transportation. Burdensome health care costs were defined as exceeding 40\% of nonessential resources. We used logistic regressions to assess the probability of incurring burdensome health expenditures, controlling for LIS eligibility.

RESULTS: In the year before Part D, more than half of Medicare families [56.0\%; 95\% confidence interval (CI): 55.3-59.9] experienced burdensome health care costs. Families in poor health allocated a median of 68.1\% [interquartile range (IQR): 35.1-82.9] of nonessential resources to health care (compared with 34.0\% median; IQR 11.9-52.2 among families in excellent health, P < 0.011). Most (64\%) out-of-pocket health care spending was allocated to health insurance premiums and medications. As many as 26\% of Medicare families had burdensome health care costs but were not eligible for LIS assistance.

CONCLUSIONS: Before Part D, burdensome health care expenditures were common in Medicare families. Our estimates of Part D and LIS benefits indicate a limited scope of relief.

}, keywords = {Adult, Aged, Confidence Intervals, Cost of Illness, Deductibles and Coinsurance, Drug Prescriptions, Female, Financing, Personal, Health Expenditures, Humans, Income, Male, Medicare Part D, Middle Aged, Odds Ratio, Poverty, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3181dbd8d3}, author = {Becky A. Briesacher and Ross-Degnan, Dennis and Anita K Wagner and Hassan Fouayzi and Fang Zhang and Jerry Gurwitz and Soumerai, Stephen B} }