Project Details


Despite the availability of Medicare, out-of-pocket health care costs
are substantial for many older persons. It is of considerable public
policy importance to understand the impact of these costs; yet recent
information on the size, composition, distribution, and financial
burden of out-of-pocket health care costs of older persons is
surprisingly scant, and there are many methodological problems with
widely-cited estimates. Using newly available data from the Medicare
Current Beneficiary Survey, we aim to provide new insight on the impact
of out-of-pocket health care costs on elderly persons. These analyses
will identify the characteristics of older people which predict high
out-of-pocket costs; provide a better understanding of the role of
privately purchased supplemental insurance, employer-provided retiree
insurance, Medicaid, and other programs in protecting older people from
such costs; characterize recent trends in out-of-pocket costs and the
changing roles of pharmaceutical costs, physician costs, insurance
premium costs, long-term care costs, and other health care costs in
total out-of-pocket expenditures; and identify the prevalence and
predictors of out-of-pocket costs which are financially burdensome in
relation to income.

Using data from the MCBS Cost and Use public use files for 1992 through
1994, we will prepare initial empirical papers describing the
composition and distribution of out-of-pocket costs among the elderly
living in the community; relating these costs to individuals' age,
health status, level of functional impairment, income, and other
individual characteristics; and analyzing the prevalence and predictors
of high out-of-pocket costs as defined by several alternative criteria.
We will also develop and validate methods and measures needed for a
more ambitious research proposal which will use MCBS data to provide
an in-depth picture of the extent, distribution, and composition of the
elderly's out-of-pocket health care costs, addressing several key
methodological problems with the use of MCBS data for this purpose and
making recommendations to the survey producers for future improvements
to MCBS. The proposed study will provide detailed description of the
elderly's out-of-pocket costs; place these costs in the context of
elderly individuals' economic, demographic, and health characteristics;
and identify the specific predictors of financially burdensome costs,
providing information critically needed to inform Medicare, Medicaid,
and other health care financing policies.
Effective start/end date9/30/978/31/99


  • National Institute on Aging


  • Public Health, Environmental and Occupational Health


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