研究 Financial and Physical Health in a Changing 医疗保健 Market

11月1日标志着开放注册季节的开始, when millions of Americans take steps to choose the right healthcare plan for themselves and their families. Consumers will be making key decisions impacting both their financial and physical health amongst a changing healthcare market, 自费支出上升, and live discussions on how to effectively reform the U.S. 卫生保健系统. 记住这个背景, we reflect on 澳博官方网站app 研究所 research that informs these issues and provides insights into how families make choices around healthcare.

Our research on medical spending has explored the link between a family’s out-of-pocket healthcare expenses and the rest of their financial life. 根据我们的 医疗保健自付支出小组 (HOSP), we have investigated the financial pressures of out-of-pocket healthcare spending, the financial burden of extraordinary medical payments, and the role of cash-flow dynamics in enabling consumers to seek medical care. 当家庭考虑他们的保险选择时, 这对政策制定者很重要, 供应商, and 纳税人 to understand the relationship between out-of-pocket expenses and how and when consumers seek and pay for medical care.

我们的研究已经广泛地证明了这一点, families across the income spectrum tend to experience a high level of income and spending volatility on a month-to-month basis. 典型的家庭经历超过 30 percent swings on a month-to-month basis in both income and spending. 我们估计每个家庭需要的液体缓冲是 六个星期的实得收入 in order to weather a simultaneous income dip and expense spike. But most families—65%—do not have such a financial buffer. 此外, out-of-pocket medical expenses can be a key source of expense volatility and financial burden. 尽管这个国家的大多数人91.5%)有健康保险, we find that one in six families (or 17 percent) make at least one extraordinary healthcare payment (more than $400 and roughly $2,(平均为1000人). Paying such a large out-of-pocket sum has long-term financial consequences; even twelve months after making an extraordinary payment, families’ had lower levels of liquid assets and higher revolving credit card balances compared to their pre-payment baseline.

事实上, as families consider their options for healthcare coverage, they will be making decisions in an environment of increasing out-of-pocket costs. 连续三年, 2014 - 2017年, out-of-pocket healthcare spending levels accelerated to a year-over-year growth rate of 8.2017年5%. 2017 out-of-pocket spending was $625 on average, and the healthcare burden increased from 1.2016年税后收入的6%降至1%.2017年7%. Growth in healthcare spending occurred across every state and demographic group. 这一趋势没有放缓的迹象, with the continued growth of high-deductible plans amidst significant support from regulators and 纳税人 guided by the belief that consumer cost accountability will rationalize healthcare utilization. 

Amid experiences of general household financial volatility and growing out-of-pocket costs, families will make a tactical choice during open enrollment season: selecting a health insurance plan. Our research provides insights that can guide consumers as they navigate this complex decision. 第一个, it is important to realize that the choice of what insurance plan is right for a family really does depend on their circumstances. This is because healthcare spending is incredibly concentrated among a small group of families. The top 10 percent of spenders—those families most financially burdened by out-of-pocket healthcare expenses—spent on average $3,255, which is five times as much as the average spender and represents 9.税后收入的5%.

此外, those with high out-of-pocket costs in one year are likely to have similar costs in the subsequent year. 从这个意义上说，医疗成本是粘性的, and those with high healthcare costs probably know who they are. 例如, women experience higher than average healthcare spend burdens, meaning they spend more on healthcare as a share of their income—about 2 percent. 一般来说, families with high healthcare spending may be better off in a plan with a low deductible and broader coverage. Families with low out-of-pocket healthcare spending may consider opting into a high-deductible plan if it has a lower insurance premium.

Families also need to think about their choice of health insurance as having direct implications for their savings behavior. We tend to think about our savings goals as separate from our choice of health insurance plan, but one of the most important things we should be provisioning for is our health, by saving for the out-of-pocket healthcare expense we might be on the hook for. 事实上, we observe in the data that liquid assets play a key role in healthcare utilization, and healthcare spending is intricately linked to cash flows. 医疗保健 spending spikes in months when a family has higher-than-average liquid assets and income; for example, 我们观察到退税引发的支出. 在退税到达后的一周内, out-of-pocket healthcare payments increased by 60 percent. 这一增长的62%用于亲自护理, rather than for healthcare bills for care received in the past. 因此, people often seek medical care when they have the money to pay for it, 不一定是他们真正需要照顾的时候, 哪些最终会对健康产生负面影响.

Families with cash reserves are better able to weather a medical expense than their counterparts without such savings and are less likely to defer health expenses until after their tax refund arrives, reinforcing the fact that healthcare spending is intricately linked to cash flows. Given the importance of a cash buffer in weathering an unexpected expense, 评估健康保险计划时, families ought to consider whether they have a sufficient financial buffer and the risk appetite to cover their deductible and maximum out of pocket costs stipulated by each plan option. 选择高免赔额计划时, families should strongly consider opening and contributing to a Health Reimbursement Accounts (HRAs) or 医疗保健 Savings Account (HSAs), which are tax efficient ways to save for short- and long-term healthcare needs. Regardless of whether families have access to HRAs or HSAs, they should take steps to establish a cash buffer sufficient to cover the deductible, 因为那是, 实际上, 家庭自行投保的金额.

In light of the challenges families have with out-of-pocket healthcare expenses, 政策制定者, 雇主, 纳税人, and 供应商 all have a role to play in helping families make better decisions regarding their healthcare. There are a number of approaches to address these challenges, 特别是, 它们可以帮助消费者管理成本, 增加透明度, 降低价格. 

• Increase competition and choice, reduce healthcare prices, and improve price transparency. The geographic view of our data shows high variation in out-of-pocket healthcare spending and burden levels across states and counties. 例如, Utah and Colorado had the highest average spending levels, 分别为864美元和797美元, while West Virginia had the lowest average spending level at $495. Our even more granular analysis at the county level illustrates that even within states, there is variation within healthcare spending and burden levels. 例如, we see in California that families in some counties have healthcare spending burdens as high as 2.56%在马林县, while others have lower out-of-pocket spending burdens like Imperial County at 0.94%. 因此, there is both variability in cost across geographies—but also a sense of uncertainty that consumers face around expected costs. Many families usually don’t know their out-of-pocket liability until after they receive a statement from their provider or benefits explanation from their insurer. This makes it difficult for families to compare prices or “shop around” for healthcare services, 更不用说计划开支了, 或者平衡他们的短期和长期需求.
  
  努力减轻这种可变性, but still encourage choice while keeping costs low have included (1) reducing drug prices, and (2) creating price transparency for healthcare goods and services prior to the point of care to avoid surprise bills. Bringing transparency to the price of health care and disclosing out-of-pocket costs can enable consumers to make healthcare choices 之前 receiving care and prevent undue burden from unexpected and unmanageable expenses. Providers also have a role to play here through efforts to improve access to information, 协助消费者规划, 简化账单. Simplifying billing can improve transparency and understanding for consumers.

• 帮助消费者管理成本 by expanding access to Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSAs). The theory goes that if consumers have “skin in the game” they will have an incentive to contain their costs and only seek high-value care. 但他们需要有人帮助他们为这些费用储蓄, and a series of efforts are underway to expand access to tax advantaged accounts to do just that. However, they also introduce a new set of financial decisions that are not easy to resolve. Consumers may face a choice to save pre-tax dollars for health alone that can roll over year-to-year, pre-tax dollars in a flexible savings account which is lost if not used, or post-tax dollars to be spent whenever and will never be lost. It’s challenging to determine which choice is the right one. These complications serve as barriers to take-up and utilization. 另外, 并不是每个人都可以使用HRAs和HSAs, further contributing to heterogeneity in the way consumers prepare for and experience healthcare expenses.

Regardless of potential policy proposals on the horizon, the decision during open enrollment is fundamentally a personal one; and our data suggest, it is a financial decision that should be considered in the broader context of one’s financial life. Given the direct implications for how much one should save in reserve for medical expenses, making an informed decision will help to ensure not only one’s financial health but also physical health.