Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures

The Article in Brief

Life Disruptions for Midlife and Older Adults With High Out-of-Pocket Health Expenditures

David Grande , and colleagues

Background American families are spending a growing amount of their personal income on health, leading them to make financial trade-offs. Little is known about the choices families make and how they make them. This study investigates the social, medical, financial, and sometimes legal disruptions from high out-of-pocket health expenses, referred to here as "life disruptions."

What This Study Found Among 33 insured patients seeking philanthropic financial assistance, all of whom face major chronic illnesses and most of whom are covered by Medicare, there is considerable anxiety, major debt problems, and disruptions of medical care because of high levels of cost sharing. Participants describe various borrowing strategies (such as credit cards), legal problems (such as debt collections), and threats to their household budgets (such as food and housing). Although participants understand their health benefits, they describe considerable anxiety about changes to those benefits that could easily disrupt carefully managed household budgets. Specifically, benefits that have large variation in financial liability from month to month (such as large deductibles or coverage gaps) impose considerable financial challenges.

Implications

• The authors urge policy makers to consider the consequences of high cost sharing for families facing strained household budgets. Continuity of benefits and month-to-month stability of financial liability are important considerations that may be undervalued in policy discussions.