Medical Expenditure Panel Survey-Household Component Research Articles

Estimated Reduction in Health Care Spending Associated With Weight Loss in Adults

Recent data from federal surveys show that more than 70% of adults have either overweight or obesity. Overweight and obesity are associated with several expensive chronic conditions, such as type 2 diabetes, heart disease, hypertension, and hyperlipidemia. The prevalence of chronic disease is a key driver of rising health care spending among employers and the Medicare program. To estimate health care spending among adults with overweight or obesity and have employer-sponsored insurance or Medicare and examine the association of higher and lower body mass index (BMI). This cross-sectional study included privately insured adults and adult Medicare beneficiaries with a BMI of 25 and higher. Data from the Medical Expenditure Panel Survey-Household Component were used to tabulate total annual health care spending. Data were analyzed from April 1 to June 20, 2024. The primary intended measures were total annual health care spending, controlling for patient demographics, income, education, and BMI. The baseline health care spending as a percentage reduction in BMI. An instrumental variable regression model with estimated total spending at various levels of BMI was used. This study included 3774 adults who were insured with Medicare (mean [SD] age, 63.1 [11.1] years; mean [SD] percentage female, 50.4% [49.7%]; mean [SD] percentage non-Hispanic Black adults, 17.4% [37.7%]; mean [SD] percentage non-Hispanic White adults, 61.3% [48.4%]). The study also included 13 435 adults who had employer-sponsored insurance (mean [SD] age, 46.3 [6.9] years; mean [SD] percentage female, 47.6% [48.9%]; mean [SD] percentage non-Hispanic Black adults, 11.1% [30.7%]; mean [SD] percentage non-Hispanic White adults, 73.1% [43.4%]). Overall, adults with employer-sponsored insurance with a weight loss of 5% were estimated to spend a mean of $670 (95% CI, $654-$686) less on health care (8% less), and those with a weight loss of 25% spent an estimated mean of $2849 (95% CI, $2783-$2916) less on health care (34% less). Among adults with Medicare who had 1 or more comorbid conditions, a 5% weight loss was estimated to reduce spending by $1262 (95% CI, $1217-$1306) (7% less) and a 25% weight loss was estimated to reduce health care spending by a mean of $5442 (95% CI, $5254-$5629) (31% less). In this cross-sectional study, projected annual savings from weight loss among US adults with obesity were substantial for both Medicare and employer-based insurance.

Recent cohorts aging into Medicare use more counseling and psychotherapy than past cohorts.

Despite recent policy interest in improving access to mental health care in Medicare, little is known about how demand for care will change among the Medicare population as newer cohorts age into the program. We documented the growing rate of counseling and psychotherapy use in the decade prior to turning age 65years among subsequent cohorts aging into Medicare. We characterized how this growth varied across demographic groups, income levels, and mental and physical health status. We present trends using data from the 2002-2017 Medical Expenditure Panel Survey HouseholdComponent. We categorized individuals into 5-year Medicare entry cohorts based on the year they turned age 65 years. Our outcome was an indicator for having a visit for counseling or psychotherapy in a given year. Employing a probit regression, we characterized visit rates across 5-year cohorts, presenting both unadjusted and covariate-adjusted results. We ran stratified regressions by subpopulations. Our sample included 54,666 individuals aged 55to 64 years, weighted to be nationally representative. The cohort aging into Medicare between 2021 and 2025 was 88% (95% CI, 57%-119%) more likely to have a counseling or psychotherapy visit between the ages of 55 and 64years compared with the cohort that gained eligibility for Medicare between 2006 and 2010 at the same age. Growth in utilization was pervasive across many subpopulations. Our findings suggest that more recent cohorts aging into Medicare seek significantly more counseling and psychotherapy than prior cohorts. This increased utilization is pervasive across subpopulations, suggesting that plans must prepare to accommodate the needs of new Medicare entrants.

Racial and ethnic disparities in mental health among breast cancer patients and survivors in the United States.

To decompose the mental health disparities between breast cancer patients and survivors (hereafter survivors) of racial and ethnic minority groups and non-Hispanic White survivors into the contributions of individual-, interpersonal-, community-, and societal-level determinants. We used data from the 2010-2020 Medical Expenditure Panel Survey Household Component (MEPS-HC). Our primary outcome was whether the person had mental health conditions or not. We employed the Kitagawa-Oaxaca-Blinder (KOB) method to understand to what extent the differences in outcomes were explained by the differences in the determinants between non-Hispanic Black or Hispanic breast cancer survivors and non-Hispanic White survivors. We also bifurcated the Hispanic sample analysis by the US-born status (and county of origin). Confidential geographic identifiers are utilized to supplement the MEPS-HC data with information on community characteristics and local healthcare resources. The prevalence of mental health conditions among non-Hispanic Black and Hispanic breast cancer survivors was 26.1% (95% CI: 20.4, 31.7) and 28.3% (95% CI: 21.9, 34.6), respectively. These rates were higher than those for their non-Hispanic White counterparts, 19.7% (95% CI: 17.4, 21.9). In our KOB model, the disparity between non-Hispanic Black and White survivors was fully explained by differences in education, health, and family structure, with community- and societal-level determinants playing no significant role. Conversely, our KOB model did not explain any of the overall differences between Hispanic and non-Hispanic White survivors. However, for foreign-born Hispanic survivors, the disparity was fully explained by a combination of individual- and societal-level determinants. Our findings, which identify specific individual-, interpersonal-, and societal- determinants that were associated with racial and ethnic differences in mental health, can be used by clinicians and policymakers to proactively address racial and ethnic disparities in health.

Adverse Childhood Experiences: Health Care Utilization And Expenditures In Adulthood.

Adverse childhood experiences (ACEs) have been shown to be strong predictors of socioeconomic status, risky health behaviors, chronic health conditions, and adverse outcomes. However, less is known about their association with adult health care utilization and expenditures. We used new data from the 2021 Medical Expenditure Panel Survey-Household Component (MEPS-HC) to provide the first nationally representative estimates of ACEs-related health care utilization and expenditure differences based on direct observation, rather than model-based extrapolation. Compared to demographically similar adults without ACEs, those with ACEs had substantially higher utilization and 26.3percent higher expenditures. The aggregate spending difference across the 157.6million US adults with ACEs was $292billion in 2021. Moreover, we observed large, graded relationships between ACEs and health status, health behaviors, and some dimensions of socioeconomic status. We also found associations between ACEs and a range of adverse adult circumstances, also newly measured in the 2021 MEPS, including financial and housing problems, social network problems, little or no life satisfaction, stress, food insecurity, verbal abuse, physical harm, and discrimination.

RWD184 Performance of the National Library of Medicine Rxmix, FDA National Drug Code Directory, and Redbook to Identify Prescription Records

The National Library of Medicine (NLM) RxMix interface and the National Drug Code (NDC) Directory by the Food and Drug Administration (FDA) are publicly available sources to identify prescription drug use in pharmacoepidemiology studies. This study compared the performance of NLM RxMix interface, FDA NDC Directory, and Micromedex Redbook® to identify frequently prescribed medication records in Medical Expenditure Panel Survey Household Component (MEPS-HC) data using the NDC generic name mapping tables.

The association of multiple chronic conditions and healthcare expenditures among adults with epilepsy in the United States

RationaleEpilepsy is a frequent neurologic condition with important financial strains on the US healthcare system. The co-occurrence of multiple chronic conditions (MCC) may have additional financial repercussions on this patient population. We aimed to assess the association of coexisting chronic conditions on healthcare expenditures among adult patients with epilepsy. MethodsWe identified a total of 1,942,413 adults (≥18 years) with epilepsy using the clinical classification code 83 from the MEPS-HC (Medical Expenditure Panel Survey Household Component) database between 2003 and 2014. Chronic conditions were selected using the clinical classification system (ccs), and categorized into 0, 1, or 2 chronic conditions in addition to epilepsy. We computed unadjusted healthcare expenditures per year and per individual (total direct healthcare expenditure, inpatient expenditure, outpatient expenditure, prescription medication expenditure, emergency room visit expenditure, home healthcare expenditure and other) by number of chronic conditions. We applied a two-part model with probit (probability of zero vs non-zero cost) and generalized linear model (GLM) gamma family and log link (for cost greater than zero) to examine the independent association between chronic conditions, and annual expenditures per individual, generating incremental costs with 0 chronic condition as reference. ResultsOver half of the patients with epilepsy had at least two chronic conditions (CC). Yearly, for each patient with one and two chronic conditions, unadjusted total healthcare expenditures were two times ($10,202; 95 %CI $6,551–13,853) to nearly three times ($21,277; 95 %CI $12,971–25,583) higher than those with no chronic conditions ($6,177; 95 %CI $4,895–7,459), respectively. In general healthcare expenditures increased with the number of chronic conditions for pre-specified cost categories. The incremental (adjusted) total healthcare expenditure increased with the number of chronic conditions (1CC vs 0 CC: $3,238; 95 %CI $524–5,851 p-value = 0.015 and ≥2 CC vs 0 CC: $8,145; 95 %CI $5,935–10,895 p-value < 0.001). In general, for all cost categories, incremental healthcare expenditures increased with the number of chronic conditions with the largest increment noted between those with 2 CC and those with 0 CC for inpatient ($2,025: 95 %CI $867–3,1830), outpatient ($2,141; 95 %CI $1,321–2,962), and medication ($1,852; 95 %CI $1,393–2,310). ConclusionChronic conditions are frequent among adult patients with epilepsy and are associated with a dose–response increase in healthcare expenditure, a difference driven by inpatient, outpatient, and medication prescription expenditures. Greater coordination of epilepsy care accounting for the presence of multiple chronic conditions may help lower the cost of epilepsy.

High Job Flexibility And Paid Sick Leave Increase Health Care Access And Use Among US Workers.

Job flexibility is an important yet underresearched aspect of work that has implications for health care access and use. This study explored the impact of job flexibility, including both its informal aspects and access to paid sick leave, on health care access and use. We analyzed data from a nationally representative sample of US workers responding to the Medical Expenditure Panel Survey-Household Component during 2017-19, combined with occupational data from the Occupational Information Network database, version 25.0. Results showed that a one-unit increase in job flexibility was associated with a 2.15-percentage-point increase in the likelihood of having an office-based health care visit in the past year and a 2.42-percentage-point increase in the likelihood of having a usual source of care. Access to paid sick leave was associated with a 3.83-percentage-point increase in the likelihood of having an office-based health care visit. Black and Hispanic workers, as well as workers with low-wage jobs, had less job flexibility and less access to paid sick leave. Reforms that increase job flexibility and efforts by health care providers to better accommodate people with inflexible jobs could improve access, utilization, and equity.

State Health Insurance Benefit Mandates and Health Care Affordability

Every US state requires private health insurers to cover certain conditions, treatments, and providers. These benefit mandates were rare as recently as the 1960s, but the average state now has more than forty. These mandates are intended to promote the affordability of necessary health care. This study aims to determine the extent to which benefit mandates succeed at this goal. Using fixed effects and difference-in-difference research designs with data from the restricted Medical Expenditure Panel Survey—Household Component (MEPS-HC), it provides the first empirical estimates of how health insurance benefit mandates affect out-of-pocket costs and total spending on health care. Both strategies find that mandates significantly reduce out-of-pocket spending, but they are divided on whether mandates also reduce overall health care spending and spending by private insurers.

PBI9 The TOTAL Medical Expenditure and out-of-Pocket Expenditure of Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis Patients in the United States

Rheumatoid Arthritis (RA) is a chronic disease that leads to significant pain, progressive joint destruction, and functional disability. Given the incurable nature, the condition causes a significant and persistent economic burden in the U.S. and worldwide. The goal is to explore the total medical expenditure, and out-of-pocket (OOP) expenditure among the following RA medication groups: non-Disease-Modifying Antirheumatic Drugs (DMARDs); TNF alpha biologics; conventional DMARDs; combined TNF alpha biologics and conventional DMARDs. This is a retrospective observational study based on the Medical Expenditure Panel Survey Household Component (MEPS-HC) data for a cohort of individuals from 2016 to 2018. A descriptive analysis measured the patient sociodemographic and personal characteristics. Weighted mean and standard deviation (SD) or the weighted median and interquartile range (IQR) were reported for the continuous variables. A chi-square test was performed to evaluate the difference of any OOP expenditure among RA patients in different medication groups. A multivariate regression with logarithmic transformation was used to estimate the relationship between total medical expenditure and RA therapeutic medication class by adjusting the confounding covariates. 1,758 adult RA patients with 10,434 RA-related events with at least one visit to the healthcare provider between 2016 and 2018 were identified. The average total medical expenditure was significantly higher in RA patients with any type of DMARD, residing in the Western U.S., diagnosed with 2 or more comorbidities, and 2 or more health resource visits. The DMARDs groups were more likely to have some positive OOP expenditures, including all patients in the TNF alpha biologics group. RA patients with TNF alpha biologics encounter higher total medical expenditure and OOP expenditures; however, they may experience fewer or no occurrences of high-cost drivers of healthcare utilization. Average OOP expenditures increased from 2016 to 2018 in RA patients with any biologic DMARD.

The economic impact of glioma survivorship: The cost of care from a patient perspective.

We aimed to characterize the socioeconomic impact of glioma for patients with clinical and radiographic evidence of disease stability, using the standardized Medical Expenditure Panel Survey-Household Component (MEPS-HC). The MEPS-HC questionnaire was used to investigate the degree of economic hardship referable to the patient's brain tumor and treatment. The questionnaire included demographic variables such as age at diagnosis, ethnicity, highest level of education, and annual household income. Descriptive statistics were used to characterize variables and between-group comparisons were evaluated using Fisher exact test. Of 127 prescreened patients, 89 of 107 eligible patients completed the survey. Pathology at diagnosis was predominantly low grade (60%). Most patients were insured at time of diagnosis (91%), married (76%), and employed (79%), with annual household incomes slightly higher than the national average. Despite this, nearly a quarter incurred debt referable to brain tumor care (24%), 53% required extended unpaid time off, and 46% retired or were no longer working. Financial burden and workforce morbidity were insensitive to tumor location, laterality, and annual household income. Patients with gross total resection at initial surgery were less likely to report ongoing limitations in daily activities (45% vs 83%, p = 0.004). Even in a population of stable, high-functioning glioma survivors, financial burden and workforce morbidity was ubiquitous across all tumor subtypes, treatment paradigms, and income levels.

Marginal Health Care Expenditure Burden Among U.S. Civilian Noninstitutionalized Individuals with Multiple Sclerosis: 2010-2015.

Multiple sclerosis (MS) is a chronic neuroinflammatory disorder with significant health care burden. However, little is known about health care expenditures since the introduction of oral agents for MS after 2010. To analyze health care expenditures in individuals with MS using Medical Expenditure Panel Survey (MEPS) data from 2010-2015. This retrospective cross-sectional study included adults (≥ 18 years) with MS (Clinical Classification Code 080) and those without MS based on the 2010-2015 full year consolidated MEPS Household Component and Medical Provider Component data files. Descriptive weighted analyses were performed to compare health care expenditures between individuals with MS and without MS. The 2-part model involving probit and generalized linear models was used to estimate the marginal increase in total health care expenditures for MS patients. There were 0.61 million patients (95% CI = 0.50-0.72) diagnosed with MS annually, accounting for a prevalence of 0.25%. The 2-part model revealed that the marginal total health care expenditures in patients diagnosed with MS were $20,103.49 (95% CI = $14,516.24-$25,690.73) more compared with those without MS. Further, the mean adjusted prescription medication expenditures for the MS group were $13,092.16 (95% CI = $9,452.20-$16,732.12) higher than the non-MS group and accounted for 65.12% of total health care expenditures in MS. MS is an expensive neuroinflammatory disease with a majority of the burden attributable to prescription medications. High prescription expenditure burden can be a barrier to optimal patient care in MS. No funding was received for this study. Hutton reports grants from Adamas, Biogen, EMD Serono, Genzyme, Hoffman-LaRoche, MedImmune, Mallinckrodt, and Novartis and fees from Biogen, Celgene, Genzyme, Genentech, and Novartis, outside the submitted work. Aparasu reports grants from Novartis, Incyte, and Astellas, outside the submitted work. Earla and Thornton have nothing to disclose. Part of the study findings was presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2019 National Conference; May 18-22, 2019; New Orleans, LA.

Financial Burdens and Barriers to Care Among Nonelderly Adults With Heart Disease: 2010-2015.

BackgroundWe examined the prevalence of high burdens and barriers to care among adults with heart disease treatment.Methods and ResultsThe participants were aged 18 to 64 years from the Medical Expenditure Panel Survey–Household Component (MEPS‐HC) for 2010–2015. High burden is out‐of‐pocket spending on care and insurance premiums >20% of income. Barriers to care are forgoing and delaying care for financial reasons. Logistic regressions were used to estimate the odds of having high burdens and barriers. Adults treated for heart disease have odds ratios (ORs) of 2.18 (95% CI, 1.91–2.50) for having high burden, 2.51 (95% CI, 2.23–2.83) for forgoing care, and 3.57 (95% CI, 3.8–4.13) for delaying care compared with adults without any chronic condition. Among adults treated for heart disease compared with adults with private group coverage, ORs for having high burdens were significantly lower among those with public insurance (OR: 0.17; 95% CI, 0.10–0.26) or the uninsured (OR: 0.58; 95% CI, 0.36–0.92) and higher among those with private nongroup insurance (OR: 5.30; 95% CI, 3.26–8.61). Compared with adults with private group coverage, ORs for delaying care were 2.07 (95% CI, 1.37–3.12) for those with public insurance, 2.64; 95% CI, 1.70–4.10) for those without insurance, and 2.16 (95% CI, 1.24–3.76) for those with private nongroup insurance.ConclusionsPublic insurance provides protection against high burdens but not against forgoing or delaying care. Future research should investigate whether and to what extent barriers to care are associated with worse health outcomes and higher costs in the long term.

QOLP-39. UNRAVELING THE TRUE COST OF CARE THROUGH ANALYSIS OF THE SOCIOECONOMIC IMPACT OF GLIOMA SURVIVORSHIP

Abstract BACKGROUND There is a paucity of data describing the socioeconomic impact and long-term implications of glioma survivorship. Objective: To characterize the socioeconomic impact of glioma survivorship using the standardized Medical Expenditure Panel Survey – Household Component (MEPS-HC). METHODS 89 of 107 eligible adult glioma survivors that were post-treatment with stable disease were enrolled. The MEPS-HC was utilized to assess the socioeconomic hardship referable to the patient’s tumor. Comparisons between groups were evaluated using a Fisher’s exact test. RESULTS 89 patients responded to the survey (response rate = 85%, female =52%). Median follow-up from diagnosis was 6.0 years (4.3, 9.2). Pathology at diagnosis was high-grade (40%) and low-grade (60. The majority of glioma survivors were insured (91%), employed (79%), and reported annual household incomes slightly above national average. Nearly a quarter incurred debt because of their tumor (24%), 53% required extended unpaid time off, and 46% retired or were no longer working. While 85% had a Karnofsky Performance Score of &gt; 90, the majority of respondents reported lost productivity and decreased ability to perform cognitive and physical tasks (69%). Financial burden and workforce morbidity were insensitive to tumor location, laterality, and annual household income. Patients with a gross-total resection (GTR) at initial surgery were less likely to report ongoing limitations in daily activities (45% v. 83%, p=0.004). CONCLUSIONS Despite the skewed population of high-functioning glioma survivors, financial burden and workforce morbidity was ubiquitous across all tumor subtypes, treatment paradigms, and income levels. Those with GTR were less likely to report ongoing limitations. There was a trend towards greater financial burden among those with frontal and temporal lesions.

Decomposing Trends in U.S. Health Care Spending Among Nonelderly Adults, 2007-2016.

Using the 2007 to 2016 Medical Expenditure Panel Survey-Household Component, this study analyzes trends in per capita health expenditures among nonelderly adults from the Great Recession to the period following full implementation of the Affordable Care Act. We find that the growth in total per capita spending-and specifically for prescription drug and emergency room spending-from 2007-2009 to 2014-2016 was largely driven by increases in expenditures per unit, that is, increases in per unit prices, quality, and/or intensity of treatment. We also find that changes in the health insurance distribution were the largest driver behind the increase in total per capita expenditures over this period, while changes in prevalence of chronic conditions explained a smaller portion of the increase. Identifying policies for containing health care spending growth requires a detailed understanding of the sources of that growth, particularly during periods of economic fluctuations, policy changes, and technological developments.

Emerging Trends in Metformin Prescribing in the United States from 2000 to 2015.

Metformin (MET) is used as first-line treatment for type 2 diabetes mellitus but has been shown to have pleiotropic effects that have expanded its use to various conditions. Limited current data exist regarding unconventional use within various patient populations. The aim of this study was to evaluate US FDA-approved and off-label MET utilization in the US from 2000 to 2015. We performed a retrospective analysis of outpatient MET prescribing in the US from 2000 to 2015. Data from the Medical Expenditure Panel Survey (MEPS) administered by the Agency of Healthcare Research and Quality were analyzed. Demographic characteristics, including age, sex, socioeconomic status, comorbidities, and region, were analyzed using the MEPS Household Component (HC). Prescription rates were defined as the annual number of MET prescriptions divided by the corresponding population estimate. Population denominators were derived using the MEPS HC. The MEPS estimates US populations based on sampled persons in the target population (civilian, non-institutionalized) for an entire year. MET prescribing is represented by population per 1000 persons. We determined if changes of MET prescribing were uniform across five age groups: < 18years, 18-29years, 30-49years, 50-64years, and 64 years and older. An estimated 553,291,094 MET prescriptions were dispensed in the US from 2000 to 2015. Prescribing rates steadily increased from 2000 to 2015. FDA-approved MET prescription rates increased from 2.27 per 1000 persons in 2000 to 235 per 1000 persons in 2015, while off-label MET prescription rates increased from 0.74 per 1000 persons in 2000 to 20.3 per 1000 persons in 2015. The top indications for off-label MET use were endocrine disorders (45.8%), cardiovascular disorders (18.2%), female reproductive disorders (12.9%), and metabolic disorders (10.9%). MET prescribing rates for FDA-approved indications increased across all age groups in 2000 and 2015, with the most substantial increase seen in adults aged 50-64years and > 65years (1.7 per 1000 persons to 20.6 per 1000 persons, and 2.3 per 1000 persons to 18.7 per 1000 persons, respectively). While off-label MET increased across all age groups from 2000 to 2015, a tenfold increase (< 1.0 to 10.6) was seen in adults aged 30-49years of age. Overall, MET use has substantially increased within the past 15years, which was mainly driven by older adults. Our study highlights the emerging prevalence of MET use in both FDA-approved and off-label indications.

Association of office-based provider visits with emergency department utilization among publicly insured stroke survivors

ObjectiveTo evaluate the association between visits to office-based providers and Emergency Department (ED) utilization among stroke survivors. MethodsWe analyzed 12-years of data representing a weighted sample of 3,317,794 publicly insured US adults aged ≥18 years with stroke, using the Medical Expenditure Panel Survey Household Component (MEPS-HC), 2003–2014 dataset. We used a negative binomial regression model that accounts for dispersion to estimate the association between office-based and ED visits controlling for covariates. We used a multivariate logistic regression model to identify independent predictors of ED visits. ResultsAnnual mean (SD) ED visits and office based visits for publicly insured stroke survivors were 0.60 (1.10) and 12.2 (19.9) respectively. Each unit increase in office based visits was associated with a 1% increase in ED visit (p = 0.008). Being unmarried (adjusted OR = 1.26; 95% CI: 1.015–1.564) and having several comorbidities (adjusted OR = 1.93; 95% CI: 1.553–2.412) were associated with a higher likelihood of at least one ED visit. The odds for an ED visit for individuals aged 45–64, those aged 65 years and above, and those with a college or higher level of education were respectively 34% (OR = 0.66; 95% CI: 0.454–0.965), 52% (OR = 0.48; 95% CI: 0.330–0.701), and 36% (OR = 0.64; 95% CI: 0.497–0.834) lower than their counterparts. ConclusionsContrary to our expectations, there was a direct relationship between ED visits and office base visits among U.S. stroke survivors. This finding may reflect the difficulties associated with managing stroke survivors with multiple co-morbidities or complex psycho-socio-economic issues.

Duration Of Uninsured Spells For Nonelderly Adults Declined After 2014.

Using longitudinal data from the Medical Expenditure Panel Survey-Household Component (MEPS-HC), we found that nonelderly respondents in 2014-15, following implementation of ACA coverage provisions, experienced shorter periods of being uninsured than did respondents in 2012-13 and 2013-14. This was particularly true for people with preexisting (or "high-risk-pool") health conditions.

PHP3 - Perceived Value of Health Insurance and Enrollment Decision Among Low-Income Population

Individual mandate is one of the key features of the Affordable Care Act. This study assesses the uninsured rate in various subgroups and describes the differences between the uninsured and the insured focusing on individuals’ attitudes toward risk. The 2014 Medical Expenditure Panel Survey-Household Component (MEPS-HC) full year consolidated data file were analyzed. The study included people in poverty who were eligible neither for public coverage nor for employer-sponsored insurance. Factors predicting likelihood of being uninsured were examined using a logit model. The study included 2,258 individuals. Thirty four percent of the sample remained uninsured. The uninsured were likely to have lower demand for insurance and perceived value of insurance. Zero doctor visit was the strongest predictor of likelihood of being uninsured. It appears that adverse selection exists in individual insurance market. The outreach efforts should focus on increasing perceived value of health insurance.

Perceived Value of Health Insurance and Enrollment Decision among Low-Income Population

The individual mandate is one of the key features of the Affordable Care Act (ACA) and has contributed to a substantial decrease in the overall uninsured rate. We examined the relationship between the individual's insurance status and his/her attitude towards risk and uncertainty among the nonelderly adults, without employer-sponsored insurance (ESI) sources and who are most likely to benefit from the ACA. A descriptive, cross-sectional study was conducted using the 2014 full-year consolidated data file from the Household Component of the Medical Expenditure Panel Survey-Household Component (MEPS-HC). This study included 4,848 individuals, aged 18-64 years, with incomes between 138-400 % of the Federal Poverty Level (FPL), and without access to public coverage or ESI. We examined the factors associated with the likelihood of being uninsured using a logit model. We found that the proportion of the uninsured among the low-income nonelderly adults without ESI (31.1%) was much higher than the one among the nonelderly adults (14.3%). The uninsured adults were likely to have lower demand for insurance and perceived value of insurance and were less likely to visit a doctor or to fill prescription drugs. More rigorous outreach efforts focusing on increasing perceived value of health insurance could contribute to an increased insurance coverage among low-income populations.

The direct cost of epilepsy in children: Evidence from the Medical Expenditure Panel Survey, 2003–2014

IntroductionEpilepsy is frequent in children and often requires complex healthcare interventions. There is a paucity of recent and detailed healthcare expenditures among children with epilepsy in the United States (US). MethodsData on children (aged ≤17years) from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) from 2003 to 2014 were analyzed. Unadjusted overall and specific cost components were compared between children with epilepsy and those without epilepsy. We used a two-part model with gamma distribution and log link for the estimation of independent incremental cost incurred by epilepsy in children. Unadjusted and adjusted mean expenditures and aggregate burden of epilepsy were estimated. ResultsOut of 54,393,387 (weighted) US children, 457,873 (0.84%) had epilepsy. Children with epilepsy had nearly six times higher healthcare expenditure than those without epilepsy ($2024 [95% confidence interval (CI): 1917–2130] vs. $12,577 [95% CI: 7922–17,231]). Unadjusted inpatient expenditure for epilepsy ($4418 [95% CI: 1550–7285) was ten times higher than that for children without epilepsy, representing more than one-third of unadjusted total direct cost. The adjusted difference in medical expenditure between children with and those without epilepsy was $8317 (95% CI: 3701–13,363). The annual unadjusted aggregate cost of epilepsy in children was approximately $5.8 billion. The annual adjusted difference in cost of epilepsy between children with and those without epilepsy was $3.8 billion. ConclusionUnadjusted and adjusted medical expenditure among children with epilepsy is high. The high expenditure is essentially driven not only by inpatient expenditure but also by home healthcare, outpatient, and medication healthcare expenditures.