Previous research has shown that families who have difficulty paying their medical bills may delay or forgo needed care. In this study, researchers sought to determine factors that affect families’ decisions to put off or go without care, including the cost of health care relative to a family’s income and having a child with a limitation such as asthma, autism or obesity.
Investigators Lauren E. Wisk and Dr. Whitney P. Witt, from the University of Wisconsin School of Medicine and Public Health, examined data from the 2001-2008 Medical Expenditure Panel Surveys on 14,138 families with at least one child.
Excessive financial burden was defined as total out-of-pocket health care expenses as a proportion of the families’ total income. Delayed or forgone care was defined as putting off or going without medical care or prescription medications for a parent or child due to cost and/or insurance-related reasons.
Results showed that families with high financial burden, having a child with an activity limitation or a parent without insurance each increased the likelihood that families would delay or go without care. For example, having a child with an activity limitation increases the odds of unmet health needs by 81 percent. However, when a parent and child had the same insurance, they were more likely to get the care they needed.
Interestingly, before the recession, children with private insurance and a consistent, appropriate usual source of care were protected against unmet need due to cost or insurance. However, those factors were not significantly protective during the recession.
Additionally, significant racial/ethnic and income-related disparities existed in the experience of delayed or forgone care. For example, families whose income was less than 400 percent of the federal poverty level were two to three times more likely to delay or go without care than families with incomes at or above 400 percent of the poverty level. Meanwhile, families who experienced more than a 10 percent decrease in their family income during the study period were also more likely to experience unmet need.
“Every U.S. family has a finite amount of resources available to them, and every day they have to make decisions about how to allocate those resources. This is especially true in today’s economy where you hear people talk about ‘feeling the pinch,’” said Wisk, a PhD student in the Department of Population Health Sciences. “This study shows the unfortunate reality of the situation. Families aren’t choosing to spend their money on going to the doctor when someone is sick because of how much it cost them to see the doctor last time. They’re sacrificing their health because it costs too much to be healthy.”
Witt says the study “provides clear evidence that families are rationing needed health care as a result of high costs. The concern is that these financial barriers to care will lead to a decline in the health of US families.”
However, Witt said the results also highlight potential solutions, specifically limiting cost-sharing, providing continuous coverage to families as a unit, and focusing on the most vulnerable families (like those with children with health problems) to ensure that needed care is received.
At Wisconsin, Witt is affiliated with the Waisman Center, the Institute for Research on Poverty, and the Center for Demography and Ecology. She is an assistant professor in the Department of Population Health Sciences at the UW School of Medicine and Public Health. The paper is available online by Springerlink at:
University of Wisconsin School of Medicine and Public Health