论将健康保险福利纳入绝对贫困趋势的重要性和内在困难。

On the Importance and Intrinsic Difficulties of Incorporating Health Insurance Benefits in Absolute Poverty Trends.

机构信息

City University of New York.

出版信息

J Health Polit Policy Law. 2023 Oct 1;48(5):761-798. doi: 10.1215/03616878-10637735.

DOI:10.1215/03616878-10637735

PMID:36995345

Abstract

CONTEXT

US government poverty measures do not include health insurance in the threshold or health insurance benefits in resources. Yet the 2019 Economic Report of the President presented long-term trends using the full-income poverty measure (FPM), which includes health insurance benefits as resources. A 2021 technical advisory report recommended statistical agencies produce absolute poverty trends with and without health insurance.

METHODS

The authors analyzed the conceptual validity and relevance of long-term absolute poverty trends incorporating health insurance benefits. They estimated the extent to which the FPM credits health insurance benefits with meeting nonhealth needs.

FINDINGS

In FPM estimates, health insurance benefits alone remove many households from poverty. Long-term absolute poverty trends incorporating health insurance benefits have intrinsic difficulties, because health insurance benefits are in-kind, mostly nonfungible, and large, and because health care undergoes substantial technological change-features that interact to undermine validity. Valid poverty measures with health insurance benefits require resources and thresholds consistent at each point in time, while absolute poverty measures require thresholds constant in real terms over time. These goals conflict.

CONCLUSIONS

Statistical agencies should not produce absolute poverty trends incorporating health insurance benefits. Instead, they should focus on less-absolute poverty measures with health insurance benefits.

摘要

背景

美国政府的贫困衡量标准不包括医疗保险的门槛或医疗保险的资源。然而，2019 年总统经济报告使用包括医疗保险福利在内的全面收入贫困衡量标准（FPM）呈现了长期趋势。2021 年的一份技术咨询报告建议统计机构制作包含和不包含医疗保险的绝对贫困趋势。

方法

作者分析了将医疗保险福利纳入长期绝对贫困趋势的概念有效性和相关性。他们估计了 FPM 认为医疗保险福利在满足非健康需求方面的作用程度。

发现

在 FPM 估计中，仅医疗保险福利就使许多家庭脱贫。将医疗保险福利纳入长期绝对贫困趋势存在内在困难，因为医疗保险福利是实物的、大多是非可互换的和大量的，而且医疗保健经历了重大的技术变革——这些特点相互作用，破坏了有效性。具有医疗保险福利的有效贫困衡量标准需要在每个时间点上资源和门槛保持一致，而绝对贫困衡量标准需要在实际时间内门槛保持不变。这些目标相互冲突。