Wyszewianski L
Health Serv Res. 1986 Dec;21(5):617-34.
This article describes the characteristics of families with catastrophic health care expenditures. Based on data from a national sample, three overlapping groups of families are considered: those incurring annual out-of-pocket expenditures that exceed, respectively, 5, 10, and 20 percent of the family's income. Such families represent a small percentage of all families, but they account for a disproportionally large share of total health care expenditures. Nevertheless, the actual amounts spent out of pocket by most of these families are relatively small. Modest sums are financially burdensome to these families because they are more likely to be low-income and to be headed by someone who is not employed. Families with catastrophic expenditures are also more likely to be headed by someone 65 or older and, consistent with that, a greater share of their total expenditures is covered by Medicare. However, all other third-party payers cover a relatively smaller share of total expenditures for these families than they do for all families, reflecting the generally worse third-party coverage of families with catastrophic health expenditures. The implications of these findings for several current issues are discussed, including catastrophic coverage proposals for Medicare and proposed programs to help the medically indigent and the uninsured.
本文描述了面临灾难性医疗支出的家庭的特征。基于全国样本数据，考虑了三组重叠的家庭：那些每年自付支出分别超过家庭收入5%、10%和20%的家庭。这类家庭在所有家庭中所占比例较小，但在医疗总支出中所占份额却不成比例地大。然而，这些家庭中大多数实际自付的金额相对较小。小额支出对这些家庭来说在经济上负担沉重，因为他们更有可能是低收入家庭且户主可能没有工作。有灾难性支出的家庭也更有可能由65岁及以上的人担任户主，与此一致的是，他们总支出中更大的份额由医疗保险覆盖。然而，与所有家庭相比，所有其他第三方支付者为这些家庭支付的总支出份额相对较小，这反映出有灾难性医疗支出的家庭的第三方保险覆盖总体上更差。讨论了这些发现对当前几个问题的影响，包括医疗保险的灾难性保险提案以及旨在帮助医疗贫困者和未参保者的拟议计划。
