The Impact of Health Care Financing on Family Budgets

1994 ◽  
Vol 24 (4) ◽  
pp. 691-714 ◽  
Author(s):  
Edith Rasell ◽  
Jared Bernstein ◽  
Kainan Tang
Keyword(s):  
Health Care ◽  
Low Income ◽  
Private Insurance ◽  
The Elderly ◽  
High Income ◽  
Medical Expenditure ◽  
Health Care Spending ◽  
Expenditure Survey ◽  
Low Income Families ◽  
The Impact

Although businesses, federal and state governments, and insurance companies are major funding sources for health care, they are just intermediate sources. Ultimately, individuals and families pay all health care costs through out-of-pocket spending, insurance premiums, or federal, state, and local taxes. Using a microsimulation model with data from the 1987 National Medical Expenditure Survey, the Internal Revenue Service's Individual Tax Model, and the Consumer Expenditure Survey, the authors examine the distribution of health care spending, by decile, among families and individuals. They find that the distribution of health expenditures is very regressive, with low-income families paying twice the share of income paid by high-income families. The distribution of out-of-pocket expenditures, which comprise 24 percent of total spending, is the most regressive, with low-income families paying 8.5 times the share of income paid by high-income families. Spending on premiums is also regressive, and the regressivity would increase if everyone had private insurance. Expenditures through the public sector are progressive. Regressivity is greater among the elderly than the nonelderly. Out-of-pocket expenditures account for 41 percent of all health care spending by the elderly. A more equitably financed health care system would increase the share of funding raised through progressive taxes, and decrease reliance on expenditures made out of pocket and on premiums.

scholarly journals Quantifying Overinsurance Tied to the Tax Exclusion for Employment-Based Health Insurance and Its Variation by Health Status

2019 ◽  
Vol 56 ◽  
pp. 004695801989385
Author(s):  
Bradley Herring ◽  
Erin Trish
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Status ◽  
Expected Utility ◽  
Low Income ◽  
Health Care Services ◽  
Medical Expenditure Panel Survey ◽  
Insurance Coverage ◽  
Medical Expenditure ◽  
Health Care Spending

The exclusion of employment-based health insurance from income and payroll taxes is thought to increase the generosity of insurance coverage and, in turn, increase the overutilization of low-value health care services. We examine this inefficiency of overinsurance by quantifying the change in expected utility across 4 benchmark plans varying in actuarial value (AV) and focus on the distribution of each of these estimates across different groups of people varying in health status. Specifically, we quantify the changes in health care spending due to moral hazard and the changes in uncertainty tied to risk aversion using data from the nationally representative sample of adults with employment-based coverage from the 2007-2016 Medical Expenditure Panel Survey, and produce estimates of expected utility for 24 groups of people based on their age, gender, and preexisting conditions. Our model suggests an average preferred AV of 78% without the tax exclusion, with 29.0% of the population preferring a 60% AV, 6.5% preferring a 70% AV, 18.1% preferring an 80% AV, and 46.4% preferring a 90% AV. When incorporating the distortionary effect of the employment-based tax exclusion, the preferred plan increases to an 83% AV for low-income people (with 71.0% of the population preferring a 90% AV) and an 84% AV for high-income people (with 76.0% of the population preferring a 90% AV). We estimate that policy changes to make subsidies independent of a plan’s AV could result in increases in utility equal to about 2.7% of total health care spending, but with those net gains concentrated among the healthy.

scholarly journals How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

2020 ◽  
Author(s):  
Andreas Koehler ◽  
Joz Motmans ◽  
Leo Mulió Alvarez ◽  
David Azul ◽  
Karen Badalyan ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Health Care ◽  
Low Income ◽  
Social Group ◽  
High Income ◽  
Transgender People ◽  
Middle Income ◽  
Transgender Health ◽  
The Impact

AbstractBackgroundSince the beginning of the COVID-19 pandemic, access to medical care was restricted for nearly all non-acute medical conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments (e.g., hormone treatment), transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic on the health and health care of transgender people.Methods and findingsAs an ad hoc collaboration between researchers, clinicians, and 23 community organizations, we developed a web-based survey. The survey was translated into 26 languages, and participants were recruited via various social media and LGBTIQ-community sources. Recruitment started in May 2020. We assessed demographical data, physical and mental health problems (e.g., chronic physical conditions), risk factors (e.g., smoking), COVID-19 data (symptoms, contact history, knowledge and concerns about COVID-19), and the influence of the COVID-19 pandemic on access to transgender health care and health-related supplies. To identify factors associated with the experience of restrictions to transgender health care, we conducted multivariate logistic regression analysis.5267 transgender people from 63 higher-middle income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding testing or treatment of a COVID-19 infection due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted due to the COVID-19 pandemic for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% of the participants reported at least one mental health conditions. Every third participant had suicidal thoughts, and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. A limitation of the study is that we did not analyze data from low-income countries and access to the internet was necessary to participate.ConclusionsTransgender people are assumed to suffer under the severity of the pandemic even more than the general population due to the intersections between their status as a vulnerable social group, their high amount of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender individuals, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behaviour, and suicidality.

Improving Access to Health Care for Children, Youth, and Pregnant Women

PEDIATRICS ◽  
1990 ◽  
Vol 86 (4) ◽  
pp. 626-635
Author(s):  
PAUL W. NEWACHECK
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Community Health Centers ◽  
Universal Access ◽  
Insurance Coverage ◽  
The Elderly ◽  
Health Insurance Coverage ◽  
Access To Health ◽  
Low Income Families

Twenty-five years ago it seemed that America was on the verge of universal health care coverage.1 A large and growing number of workers and their dependents had gained employer-based health insurance coverage.2 Medicaid and Medicare were enacted to serve the needs of those who did not work—notably the poor and the elderly. Direct service programs, such as community health centers, maternal and infant care projects, and children and youth projects, were also established in the mid-1960s to serve low-income families. At the time, it appeared that this pluralistic approach to financing health care was leading to universal access to health care.

Household Dysfunction Is Associated With Bullying Behavior in 10-year-old Children: Do Socioeconomic Circumstances Matter?

2021 ◽  
pp. 088626052110063
Author(s):  
Sílvia Fraga ◽  
Sara Soares ◽  
Flávia Soares Peres ◽  
Henrique Barros
Keyword(s):  
Low Income ◽  
Partner Violence ◽  
Protective Factor ◽  
Physical Violence ◽  
High Income ◽  
Household Dysfunction ◽  
Bully Victims ◽  
Bullying Behavior ◽  
Low Income Families ◽  
The Impact

This study measured the prevalence of bullying behavior in 10-year-old children and investigated the effect of the socioeconomic context on the impact of household dysfunction on bullying. We studied 5,338 members of the Portuguese Generation XXI birth cohort. Information on involvement in bullying, socioeconomic characteristics, and household dysfunction was collected by trained interviewers using structured questionnaires. Being a victim of bullying was reported by 14.4% of participants, being a bully by 1.4%, and being a bully-victim by 3.9%. Being a victim or both bully-victim, simultaneously, was more frequent among children from medium-high income families. Also, children from low-income families who reported household substance abuse, witnessed parents’ intimate partner violence, and were victims of physical violence, were more frequently victims of bullying; and those who experienced family violence were more frequently involved as bully-victims. Among children from medium-high income families, all these household adversity experiences significantly increased the odds of being victim, bully, or bully-victim. Thus, although children from medium-high income families are less likely to experience adversity at home, when it happens, there is a greater effect on their behavior, suggesting that better socioeconomic circumstances do not seem to act as a protective factor.

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

Monitoring the Impact of Family Health Benefits for Low-Income Families

2001 ◽  
Author(s):  
Trish Livingstone ◽  
Lisa Lix ◽  
Mary McNutt ◽  
Evan Morris ◽  
William Osei ◽  
...  
Keyword(s):  
Low Income ◽  
Health Benefits ◽  
Family Health ◽  
Low Income Families ◽  
The Impact

scholarly journals “You run out of hope:” An Exploration of Low-Income Parents’ Experiences with Food Insecurity using Photovoice

2021 ◽  
pp. 1-21
Author(s):  
Payge Lindow ◽  
Irene H. Yen ◽  
Mingyu Xiao ◽  
Cindy W. Leung
Keyword(s):  
Food Insecurity ◽  
San Francisco ◽  
Low Income ◽  
Eating Behaviors ◽  
Comparative Method ◽  
Well Being ◽  
Structured Interviews ◽  
Unhealthy Eating ◽  
Low Income Families ◽  
The Impact

ABSTRACT Objective: Using an adaption of the Photovoice method, this study explored how food insecurity affected parents’ ability to provide food for their family, their strategies for managing household food insecurity, and the impact of food insecurity on their well-being. Design: Parents submitted photos around their families’ experiences with food insecurity. Afterwards, they completed in-depth, semi-structured interviews about their photos. The interviews were transcribed and analyzed for thematic content using the constant comparative method. Setting: San Francisco Bay Area, California, USA. Subjects: 17 parents (14 mothers and 3 fathers) were recruited from a broader qualitative study on understanding the experiences of food insecurity in low-income families. Results: Four themes were identified from the parents’ photos and interviews. First, parents described multiple aspects of their food environment that promoted unhealthy eating behaviors. Second, parents shared strategies they employed to acquire food with limited resources. Third, parents expressed feelings of shame, guilt, and distress resulting from their experience of food insecurity. And finally, parents described treating their children to special foods to cultivate a sense of normalcy. Conclusions: Parents highlighted the external contributors and internal struggles of their experiences of food insecurity. Additional research to understand the experiences of the food-insecure families may help to improve nutrition interventions targeting this structurally vulnerable population.

scholarly journals The impact of chronic disease and disability on the elderly

1999 ◽  
Vol 55 (3) ◽  
pp. 9-14
Author(s):  
C. J. Eales
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Health Care Systems ◽  
The Elderly ◽  
Therapeutic Interventions ◽  
Elderly Persons ◽  
Care Systems ◽  
And Function ◽  
The Impact

Health care systems for elderly people should aim to delay the onset of illness, reducing the final period of infirmity and illness to the shortest possible time. The most effective way to achieve this is by health education and preventative medicine to maintain mobility and function. Changes in life style even in late life may result in improved health, effectively decreasing the incidence of chronic diseases associated with advancing age. This paper presents the problems experienced by elderly persons with chronic diseases and disabilities with indications for meaningful therapeutic interventions.

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