Burden Of Health Care Expenditures Research Articles

Out-of-pocket expenditure burdens in patients with cardiovascular conditions and psychological distress: a nationwide cross-sectional study

ObjectivesThis study aimed to estimate the prevalence of psychological distress in individuals with and without cardiovascular risks and events [cardiovascular disease (CVD) conditions] and the incremental effects of psychological distress on the out-of-pocket health care expenditure burdens. MethodsWe used data from the Comprehensive Survey of Living Conditions 2007, a nationally representative cross-sectional survey in Japan. Psychological distress assessed by the K6 scale, the presence of treated CVD conditions and out-of-pocket health care expenditures as a share of household consumption expenditures were self-reported by 20,763 individuals living alone and aged between 20 and 59 years. ResultsIndividuals with obesity [adjusted odds ratio (AOR), 4.3], stroke (AOR, 3.2), ischemic heart disease (AOR, 2.3), hyperlipidemia (AOR, 1.8) or diabetes (AOR, 1.7) were more likely than those without to have serious psychological distress (SPD). With the exception of ischemic heart disease, less than half of CVD patients comorbid with SPD received treatment for mental illness. Patients comorbid with SPD and obesity (AOR, 6.1), SPD and ischemic heart disease (AOR, 3.4), and SPD and hypertension (AOR, 2.6) had higher out-of-pocket burdens than patients with only CVD conditions. ConclusionsOur findings suggest the need for physicians to identify and manage SPD in patients with CVD conditions and for policymakers to find solutions to reduce the high out-of-pocket burdens among these patients.

Out‐of‐pocket health care expenditure burden for Medicare beneficiaries with cancer

There is increasing concern regarding the financial burden of care on cancer patients and their families. Medicare beneficiaries often have extensive comorbidities and limited financial resources, and may face substantial cost sharing even with supplemental coverage. In the current study, the authors examined out-of-pocket (OOP) spending and burden relative to income for Medicare beneficiaries with cancer. This retrospective, observational study pooled data for 1997 through 2007 from the Medicare Current Beneficiary Survey linked to Medicare claims. Medicare beneficiaries with newly diagnosed cancer were selected using claims-based diagnoses. Generalized linear models were used to estimate OOP spending. Logistic regression models identified factors associated with a high OOP burden, defined as spending > 20% of one's income during the cancer diagnosis and subsequent year. The cohort included 1868 beneficiaries with and 10,047 without cancer. Compared with the noncancer cohort, cancer patients were older, had more comorbidities, and were more likely to lack supplemental coverage. The mean OOP spending for cancer patients was $4727. Cancer patients faced an adjusted $976 (P < .01) incremental OOP spending. Greater than one-quarter (28%) of beneficiaries with cancer experienced a high OOP burden compared with 16% of beneficiaries without cancer (P < .001). Supplemental insurance and higher income were found to be protective against a high OOP burden, whereas assets, comorbidity, and receipt of cancer-directed radiation and antineoplastic therapy were associated with a higher OOP burden. Medicare beneficiaries with cancer face a higher OOP burden than their counterparts without cancer; some of the higher burden was explained by the higher comorbidity burden and lack of supplemental insurance noted among these patients. Financial pressures may discourage some elderly patients from pursuing treatment.

The Burden of Maternal Health Care Expenditure in India: Multilevel Analysis of National Data

To quantify the economic burden of maternal health care services on Indian households and examine the levels of expenditure incurred in public and private health care institutions at the national, state and community levels. Cross-sectional population data from the 2004 National Sample Survey Organisation were used, which considered 9,643 households for the analysis where at least one woman received maternal health care services during the year preceding the survey. Multilevel linear regression techniques were used to estimate the effect of household, cluster and state characteristics on the proportion of maternal health care expenditures over total household expenditures. Over 80% of households reported paying for maternal health care services, with those using private care facilities paying almost 4times more than those using public facilities. Multilevel analyses show evidence of high burden of maternal health care expenditures, which varied significantly across states according to the level of health care utilisation, and with considerable heterogeneity at the household and community levels. Maternal health care services in India are offered free at the point of delivery, yet many families face significant out-of-pocket expenditures. The recent governmental policy interventions to encourage institutional births by providing nominal financial assistance is a welcome step but this might not help to compensate mothers for other indirect expenditures, especially those living in rural areas and poorer communities who are increasingly seeking care in private facilities.

The aging motorcyclist

The industry statistics demonstrates an increasingly older population is riding motorcycles. This study was designed to identify the orthopedic injuries and their hospital outcome for riders older than 50 years versus younger than 50 years. We identified all patients who were injured in a motorcycle collision between 2004 and 2009. The charts were reviewed to obtain demographic data, initial injury severity markers, and hospital outcome measures. Radiographs were reviewed and all fractures classified according to the AO/OTA system. Statistical analysis was completed with patients grouped into age <50 years versus ≥ 50 years with p ≤ 0.05 determined as significant. There were 436 patients who comprised the study population. Older patients had more medical comorbidities at the time of injury (p < 0.001). There was no significant difference between age groups for any initial injury severity markers or fracture complexity. Older patients had a longer average length of stay (p < 0.05), intensive care unit days (p < 0.001), ventilator days (p = 0.001), and rate of complications than younger patients (p < 0.05). Older patients had a significantly higher mortality rate (6.8% vs. 2.4%; p = 0.04). Advanced age demonstrated correlation with prolonged hospital stay and requirement of more aggressive medical care. An increased risk of mortality was demonstrated for the older motorcyclist. However, age alone did not affect the severity or distribution of orthopedic injuries in this study. As the motorcycle riding population ages, it is important to understand the injuries and hospital course of these patients, along with the increased mortality rates and health care expenditure burden which can be expected. Epidemiological study, level III.

Out-of-pocket (OOP) health care expenditure burden for Medicare beneficiaries with cancer.

6075 Background: Concern is increasing about the OOP burden faced by cancer patients (pts). Medicare beneficiaries have multiple comorbidities, have limited financial resources, and may face substantial cost sharing under traditional Medicare if they do not have generous supplemental coverage. We examined OOP spending and burden relative to income for Medicare beneficiaries with cancer, compared to a non-cancer comparison group. Methods: We used Medicare Current Beneficiary Survey data (1997-2007). Newly diagnosed cancer pts were selected using ICD-9CM codes on claims after a 12 mos washout period. OOP spending was assessed using self report for the index(diagnosis) and subsequent year. Pt characteristics were self reported. Generalized Linear Models estimated effects of pt characteristics on OOP spending; logistic regression identified pt characteristics associated with high burden, defined as OOP spending &gt;20% of income. Results: The cohort included 1,869 beneficiaries with, and 10,057 beneficiaries without cancer. Relative to the non-cancer cohort, cancer pts were older, had greater comorbidities, and were more likely to lack supplemental coverage (22 vs 16%) (all at p&lt;0.01).OOP spending was $4,727 or 11.4% of total spending for cancer pts. The unadjusted difference between cancer and non-cancer pts in OOP spending was $1,518 (p&lt;.001); with adjustment for patient characteristics, cancer patients faced an incremental $956 (p&lt;.01) in OOP spending. Median[mean] OOP/income was 10%[24%] for beneficiaries with, compared to 6%[14%] without cancer (p&lt;.001). Over ¼ (28%) of beneficiaries with cancer spent 20% of their income OOP, compared to 16% of beneficiaries without cancer (p&lt;.001). Supplemental insurance and higher income were protective against high OOP burden, whereas assets, comorbidity, and receipt of cancer-directed radiation and antineoplastic therapy were associated with higher OOP burden. Conclusions: Medicare beneficiaries with cancer face higher OOP burden than their counterparts without cancer; some of the higher burden was explained by higher comorbidity burden and lack of supplemental insurance. Financial pressures may discourage some elderly patients from pursuing treatment.

Resistance Training in Type II Diabetes Mellitus: Impact on Areas of Metabolic Dysfunction in Skeletal Muscle and Potential Impact on Bone

The prevalence of Type II Diabetes mellitus (T2DM) is increasing rapidly and will continue to be a major healthcare expenditure burden. As such, identification of effective lifestyle treatments is paramount. Skeletal muscle and bone display metabolic and functional disruption in T2DM. Skeletal muscle in T2DM is characterized by insulin resistance, impaired glycogen synthesis, impairments in mitochondria, and lipid accumulation. Bone quality in T2DM is decreased, potentially due to the effects of advanced glycation endproducts on collagen, impaired osteoblast activity, and lipid accumulation. Although exercise is widely recognized as an important component of treatment for T2DM, the focus has largely been on aerobic exercise. Emerging research suggests that resistance training (strength training) may impose potent and unique benefits in T2DM. The purpose of this review is to examine the role of resistance training in treating the dysfunction in skeletal muscle and the potential role for resistance training in treating the associated dysfunction in bone.

How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

Background The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic tests. Methods All diagnostic costs between 2006 and 2008 of the internal medicine department of the VU University Centre were evaluated. A target was set to reduce diagnostic expenditure by 7.5% in 2009 compared to 2008. A few interventions were introduced including introducing posters and pocket cards detailing the costs of diagnostic tests, six weekly feedback on diagnostics costs, mentorship of junior doctors, unbundling panel tests and increasing protocol adherence. Main outcome measures were the reduction in the total diagnostic costs and the total number of laboratory tests performed in the internal medicine department in 2009. Results In 2009, we achieved a 13% reduction in the total diagnostic costs compared to 2008. The department of internal medicine spent 2.80 million euro and 2.45 million euro on the diagnostic tests in 2008 and 2009 respectively and thereby saved 350.000 euro in 2009. The largest reduction was achieved by reducing the number of laboratory tests performed. Conclusion Introduction of a few simple measures to improve awareness among the physicians led to a significant reduction in the diagnostic costs in the department of internal medicine. Extending these measures to the entire hospital and even entire country will in our opinion lead to significant reduction in the health care costs.

National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008

To compare the prevalence of high out-of-pocket burdens among patients with cancer with other chronically ill and well patients, and to examine the sociodemographic characteristics associated with high burdens among patients with cancer. The sample included persons 18 to 64 years of age who received treatment for cancer, taken from a nationally representative sample of the US population from the 2001 to 2008 Medical Expenditure Panel Survey. We examined the proportion of persons living in families with high out-of-pocket burdens associated with medical spending, including insurance premiums, relative to income, defining high health care (total) burden as spending more than 20% of income on health care (and premiums). The risk of high burdens is significantly greater for patients with cancer compared with other chronically ill and well patients. We find that 13.4% of patients with cancer had high total burdens, in contrast to 9.7% among those with other chronic conditions and 4.4% among those without chronic conditions. Among nonelderly persons with cancer, the following were associated with higher out-of-pocket burdens: private nongroup insurance, age 55 to 64 years, non-Hispanic black, never married or widowed, one child or no children, unemployed, lower income, lower education level, living in nonmetropolitan statistical areas, and having other chronic conditions. High burdens may affect treatment choice and deter patients from getting care. Thus, although a detailed patient-physician discussion of costs of care may not be feasible, we believe that an awareness of out-of-pocket burdens among patients with cancer is useful for clinical oncologists.

Review Series: Examples of Chronic Care Model: The home-based chronic care model: Redesigning home health for high quality care delivery

Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

Abstract B86: Health care utilization during transition to Medicare coverage in patients with prostate cancer: Evidence from CaPSURE registry

Abstract Introduction: While Medicare eligibility for all adults who reach 65 years of age provide universal insurance coverage, disparity in utilization of medical services still persists. The purpose of our study is to evaluate utilization of medical services and general health-related quality of life outcomes in patients with prostate cancer during their transition to the Medicare coverage. We hypothesize that transition to universal coverage, especially the one that provides expanded services will lead to increase in utilization of the medical services and improvements in quality of life. Methods: Data from CaPSURE™ (Cancer of the Prostate Strategic Urological Research Endeavor), a longitudinal, observational registry of men with biopsy-proven prostate adenocarcinoma, was used for this study. Patients, who were diagnosed within 6 months of treatment, treated with Radical Prostatectomy (RP), External Beam Radiation (EBRT) and Brachytherapy (BT) and were younger than 65 at diagnosis were eligible for the study. In addition, participants had to have questionnaire assessments within 4 years (2 years before and 2 years after) of turning 65. Utilization of the medical services was measured by 1) total number of office visits; 2) number of visits related to prostate cancer care; 3) number of visits not related to prostate cancer care; 4) number of visits to physicians, 5) number of visits to non-physician health professionals, 6) total number of diagnostic tests, 7) number of diagnostic tests related to prostate cancer, and 8) number of diagnostic tests not related to prostate cancer. Change in insurance coverage was identified by No change in coverage, Change to Medicare only and change to Medicare plus supplement. Repeated measures analysis with mixed modeling was implemented to evaluate relationship between utilization of medical services, general HRQOL and transition in the insurance coverage overtime. Results: 861 participants met study inclusion and exclusion criteria. Utilization of the medical services and general health related outcomes differed among participants in different categories of transition when evaluated by univariate analysis. Participants in Medicare+ group had higher number of total office visits, non-prostate cancer related visits, physician, and non-physician medical professional visits, and diagnostic tests compared to NC and Medicare groups. However, number of visits and diagnostic tests related to prostate cancer was not affected by insurance transition. In the multivariate analysis, transition to Medicare+ was associated with higher total and non-prostate cancer related diagnostic tests. Office visits utilization was higher in Medicare+ group but association did not retain statistical significance. Similar to univariate analysis utilization of the visits and diagnostic tests related to prostate cancer was not associated with changes in insurance coverage. Conclusion: Our study demonstrated that in the population of men diagnosed with prostate cancer disparity in utilization of medical visits and use of diagnostic tests was associated with presence or absence of expanded Medicare coverage. This information provides an important insight on burden of health care expenditures in older adults with cancer. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B86.

Access to care and medicines, burden of health care expenditures, and risk protection: Results from the World Health Survey

We assessed the contribution of health insurance and a functioning public sector to access to care and medicines and household economic burden. We used descriptive and logistic regression analyses on 2002/3 World Health Survey data in 70 countries. Across countries, 286,803 households and 276,362 respondents contributed data. More than 90% of households had access to acute care. However, less than half of respondents with a chronic condition reported access. In 51 low and middle income countries (LMIC), health care expenditures accounted for 13-32% of total 4-week household expenditures. One in four poor households in low income countries incurred potentially catastrophic health care expenses and more than 40% used savings, borrowed money, or sold assets to pay for care. Between 41% and 56% of households in LMIC spent 100% of health care expenditures on medicines. Health insurance and a functioning public sector were both associated with better access to care and lower risk of economic burden. To improve access, policy makers should improve public sector provision of care, increase health insurance coverage, and expand medicines benefit policies in health insurance systems.

Relative Financial Burden of Health Care Expenditures

Out-of-pocket health expenditures potentially have a large impact on patients, particularly those with low incomes, leading to reduced utilization of health services and even bankruptcy. This analysis examines the burden of out-of-pocket spending, relative to total income, across several demographic groups. Rural residents had a higher relative burden than urban residents, as did women and Whites. Important policy implications are discussed.

The effect of tax subsidies on high health care expenditure burdens in the United States

Previous analyses of families with high health care expenditure burdens have ignored the potentially mitigating effects of tax subsidies. This analysis uses data from the Medical Expenditure Panel Survey (MEPS) to fill this gap. A range of health expenditure burden measures are computed, with and without tax subsidies, showing the impact that tax subsidies have on both the prevalence and magnitude of high health care spending burdens among the nonelderly.

Health Care Utilization, Access, and Expenditures for Infants and Young Children With Special Health Care Needs

Special health care needs in the very young are on the rise. Understanding how health care systems provide service for these children is essential. We report on the prevalence of infants and young children with special health care needs (IYCSHCN), and delineate their access to health care, utilization, expenditures, and the financial impact on families. Using data from the 2001 and 2002 Medical Expenditure Panel Survey, we performed statistical analysis on the prevalence, demographics, utilization rates, expenditures, and out-of-pocket expenses for IYCSHCN to determine the impact on families, medical systems, and health care providers. An estimated 2.6 million children younger than 6 in the United States have special health care needs. These children have greater health care service needs as demonstrated by significantly higher utilization rates for all services. Although IYCSHCN were more likely to have a usual source of care, they were more likely than other children to have access issues. As expected, health care expenditures were markedly higher for IYCSHCN ($2923 per year) than those of their healthy peers ($770 per year). Families of IYCSHCN disproportionately felt the financial burden of health care, with more than 10% of families reporting out-of-pocket health care expenditures above $500 annually. The burden of disease and health care expenditures for families of IYCSHCN is substantial. Certain characteristics, such as having insurance, help protect families from high out-of-pocket expenses. Individuals who provide health care and educational services should be aware of the financial impact of service utilization and the issues faced by families in terms of access to care and out-of-pocket expenses. Health care policy changes may be necessary to ensure that needed care for IYCSHCN is accessible and affordable.

Health Care Expenditure Burden of Persisting Herpes Zoster Pain

Pain can persist long after the resolution of herpes zoster, but little is known regarding its health care costs. The objective of this study was to determine the health care expenditures associated with persisting pain following herpes zoster by comparing expenditures for patients with postherpetic neuralgia or subacute herpetic neuralgia with a control group without these conditions. Health care expenditures attributable to persisting pain in herpes zoster patients were calculated using Thomson-Medstat's MarketScan databases to examine commercial, Medicare, and Medicaid claims for inpatient and outpatient services and outpatient prescription drugs. Excess annualized costs were $4,917 for commercially insured patients, $2,696 for Medicare patients, and $9,310 for Medicaid patients. The substantial health care costs associated with persisting pain in herpes zoster have important public health implications given evidence that the incidence of herpes zoster is increasing and that the population is aging in the United States. The results provide a basis for evaluating the cost-effectiveness of existing treatments and emerging prevention strategies.

PP_010: Health Care Utilization, Access, and Expenditures for Infants and Young Children With Special Health Care Needs

Special health care needs in the very young are on the rise. Understanding how health care systems provide service for these children is essential. We report on the prevalence of infants and young children with special health care needs (IYCSHCN), and delineate their access to health care, utilization, expenditures, and the financial impact on families. Using data from the 2001 and 2002 Medical Expenditure Panel Survey, we performed statistical analysis on the prevalence, demographics, utilization rates, expenditures, and out-of-pocket expenses for IYCSHCN to determine the impact on families, medical systems, and health care providers. An estimated 2.6 million children younger than 6 in the United States have special health care needs. These children have greater health care service needs as demonstrated by significantly higher utilization rates for all services. Although IYCSHCN were more likely to have a usual source of care, they were more likely than other children to have access issues. As expected, health care expenditures were markedly higher for IYCSHCN ($2923 per year) than those of their healthy peers ($770 per year). Families of IYCSHCN disproportionately felt the financial burden of health care, with more than 10% of families reporting out-of-pocket health care expenditures above $500 annually. The burden of disease and health care expenditures for families of IYCSHCN is substantial. Certain characteristics, such as having insurance, help protect families from high out-of-pocket expenses. Individuals who provide health care and educational services should be aware of the financial impact of service utilization and the issues faced by families in terms of access to care and out-of-pocket expenses. Health care policy changes may be necessary to ensure that needed care for IYCSHCN is accessible and affordable.

Health Care Expenditure Burdens Among Adults With Diabetes in 2001

High out-of-pocket costs can pose a significant burden on patients with chronic conditions such as diabetes and contribute to decreased treatment adherence. We examined financial burdens among adults with diabetes using nationally representative data. estimated how frequently adults with diabetes live in families in which spending on health insurance premiums and health care services exceed a specified percentage of family-level after-tax disposable income. We found that adults with diabetes face greater risks of high burdens compared with adults with any other highly prevalent medical condition. Adults with diabetes have lower incomes and pay a higher share of total expenditures out-of-pocket compared with adults with heart disease, hypertension, and cancer. Among adults with diabetes, women, those who live in poverty, and those with coexisting conditions are more likely to bear high burdens. Among nonelderly adults, those with public coverage and the uninsured have greater risk of high burdens compared with those with private insurance. More than 23% of the uninsured and more than 20% of those with public coverage spend more than half of their disposable income on health care. Among the elderly, those with private nonemployment related insurance have the greatest risk of high burdens followed by those with Medicare only, those with private employment-related coverage, and those enrolled in Medicaid. Prescription medications and diabetic supplies account for 63% to 70% of out-of-pocket expenditures among the nonelderly and 62% to 69% among the elderly. Our study identifies the subpopulations among adults with diabetes who are more likely to have high burdens, so that intervention measures can be targeted to help reduce treatment noncompliance. Our analysis also emphasizes the role of medications and diabetic supplies in contributing to high out-of-pocket burdens.

Out-of-pocket financial burden for low-income families with children: socioeconomic disparities and effects of insurance.

To determine whether socioeconomic disparities exist in the financial burden of out-of-pocket (OOP) health care expenditures for families with children, and whether health insurance coverage decreases financial burden for low-income families. The Household Component of the 2001 Medical Expenditure Panel Survey. Cross-sectional family-level analysis. We used bivariate statistics to examine whether financial burden varied by poverty level. Multivariate regression models were used to assess whether family insurance coverage was associated with level of financial burden for low-income families. The main outcome was financial burden, defined as the proportion of family income spent on OOP health care expenditures, including premiums, for all family members. We aggregated annual OOP expenditures for all members of 4,531 families with a child <18 years old. Family insurance coverage was categorized as follows: (1) all members publicly insured all year, (2) all members privately insured all year, (3) all members uninsured all year, (4) partial coverage, or (5) mix of public and private with no uninsured periods. A regressive gradient was noted for financial burden across income groups, with families with incomes <100 percent of the Federal Poverty Level (FPL) spending a mean of 119.66 US dollars OOP per 1,000 US dollars of family income and families with incomes 100-199 percent FPL spending 66.30 US dollars OOP per 1,000 US dollars, compared with 37.75 US dollars for families with incomes >400 percent FPL. For low-income families (<200 percent FPL), there was a 785 percent decrease in financial burden for those with full-year public coverage compared with those with full-year private insurance (p < .001). Socioeconomic disparities exist in the financial burden of OOP health care expenditures for families with children. For low-income families, full-year public coverage provides significantly greater protection from financial burden than full-year private coverage.

The Economic Burden of Health Care, Funeral, and Burial Expenditures at the End of Life

Research suggests that widows and wodowers experience substantial economic vulnerability. Using nationally representative data from the Consumer Expenditure Surveys 1980–2000, we describe pre‐widowhood shifts in medical and funeral/burial expenditures and discuss how these changes may affect post‐widowhood economic well‐being. Our analyses suggest that funeral/burial and medical expenditures, when combined, typically constitute a 63.1% income share for recently widowed households. Discussion focuses on what role consumer educators can play in helping families better manage end‐of‐life expenditures.

Health care expenditure burdens among elderly adults: 1987 and 1996.

Concerns about the health care expenditure burdens of elderly adults underlie the ongoing debate over expanding Medicare benefits and strengthening Medicare+Choice. We examine burdens for this population using data from the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). We estimate how frequently elderly adults live in families whose health expenditures exceed 20% or 40% of their after-tax disposable incomes. Our methodology reduces bias due to errors in income while providing an intuitive measure of exposure to the risk of high burdens. Despite rapid increases in medical care prices, the percentage of elderly adults facing burdens over 20% of disposable income remained essentially constant at 20.9% in 1987 and 22.9% in 1996. The percentage with burdens exceeding 40% of disposable income was 7.3% in 1987 and 7.9% in 1996. High expenditure burdens were more prevalent among elderly adults who were poorer, older, female, higher risk, and covered only by traditional Medicare. Medicaid coverage helped to reduce burdens among the elderly poor, yet incomplete Medicaid take-up in 1996 left approximately 1.3 million elderly adults eligible for Medicaid but covered only by traditional Medicare. Our results highlight the widespread prevalence of high health care expenditure burdens among elderly adults and the varying extent to which insurance coverage helped to protect them from rising health care expenditures between 1987 and 1996.