The study authors examined healthcare spending trends from 1977 to 2014 based on the National Medical Care Expenditure Surveys and Medical Expenditure Panel Surveys. The findings came from a secondary analysis of 21 AHRQ surveys conducted over the past 40 years as well as data on the patients’ self-reported health status.
As legislators seek to reform the healthcare system, an understanding of the low spending population, which has remained stable over time, is important. “If insurance coverage of this group declines, insurers’ ability to offer affordable coverage to high spenders with greater need will also decline,” the article authors wrote. “While the ACA has clearly had a dramatic effect on coverage, 28.6 million people remained uninsured in 2015. Ongoing monitoring of the low-expenditure population will remain a necessary component of any evaluation of healthcare reform.”
The study authors found:
1. Among those in the bottom half of the spending pool in 2014, 31 percent were 18 years old or younger, compared with 16 percent of high spenders in the top half being younger than 18. Just 5 percent of the low spenders were 65 years old or older, compared to 25 percent of high spenders.
2. Elderly patients didn’t make up the majority of the top 1 percent of spenders; only 38 percent of the top 1 percent of spenders were elderly.
3. The low spender population also believes they are healthier, as only 5 percent in 2014 said they were in fair or poor health; 17 percent of all spenders reported the same.
4. Most of the high spenders — over 50 percent — report having employee-sponsored insurance; 44 percent of low spenders report the same. High spenders were more likely than low spenders to have public coverage and a large proportion of the low spenders—around 16 percent—didn’t have health insurance in 2014. However, that number is down from 21 percent in 2013.
5. Less than 4 percent of the high spenders didn’t have health insurance coverage.
6. Among the low spenders, less than 7 percent reported lacking immediate access to care; however 33 percent said they didn’t have a “usual source of care.” High spenders were more likely to have issues accessing immediate care and 21 percent of the top 1 percent of spenders had a problem with immediate care access.
7. Low spenders reported low out-of-pocket expenditures, spending $75 out-of-pocket on average; by comparison, the low spenders in 1977 spent $94 on average per year adjusted to 2014 dollars. However, the high spenders reported spending $1,096 on average out-of-pocket in 2014.
8. Half of the low spenders didn’t have out-of-pocket expenses at all in 2014; 6.1 percent of high spenders reported the same, according to the study.
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