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

Health Services Research, Dec, 2005 by Alison A. Galbraith, Sabrina T. Wong, Sue E. Kim, Paul W. Newacheck

Figure 1: Mean Out-of-Pocket Health Care Expenditures per $1,000 of
Family Income for Different Income Groups

                Premiums    health services

<100% FPL         44.41         75.25
100-199% FPL      35.57         30.73
200-400% FPL      32.48         23.49
>400% FPL         22.20         15.55
Total Sample
  Mean            31.10         28.85

Note: Table made from bar graph.

Table 1: Descriptive Characteristics of Study Families

                                                 No. (%) or Mean

Total families                                    4,531 (100)
Mean family size                                      4.0
Race/ethnicity of reference person
  White                                           2,436 (53.8)
  Black                                             733 (42.6)
  Hispanic                                        1,194 (3.7)
  Other                                             168
Highest education level in family
  No degree                                         650 (14.4)
  High school or equivalent                       1,548 (34.2)
  Some college                                    1,131 (25.0)
  College or higher                               1,202 (26.5)
Region of residence
  Northeast                                         688 (15.2)
  Midwest                                           913 (20.2)
  South                                           1,731 (38.2)
  West                                            1,199 (26.5)
MSA
  Yes                                             3,654 (80.6)
  No                                                877 (19.4)
Family income (% FPL)
  <100                                              774 (17.1)
  100-199                                         1,066 (23.5)
  200-399                                         1,557 (34.4)
  >400                                            1,134 (25.0)
Insurance coverage
  Public insurance for all members all year         262 (5.8)
  Private insurance for all members all year      1,930 (42.6)
  All members uninsured all year                    226 (5.0)
  Partial insurance coverage                      1,050 (23.2)
  Mix of public and private insurance             1,063 (23.5)
Worst health status of any member
  Fair/poor                                         912 (20.1)
  Good/very good/excellent                        3,619 (79.9)
Family member with any limitation of activity
  Yes                                               760 (16.8)
  No                                              3,771 (83.2)

Data are unweighted.

Percentages may not add to 100% because of rounding.

MSA, metropolitan statistical area; FPL, federal poverty level.

Table 2: Summary Table of Mean Out-of-Pocket Expenditures and Income
for Families

                          Mean Out-of-Pocket Expenditures

                  Health Services ($)    Premiums ($)    Total ($)

Family income
  < 100% FPL             627.90              376.27      1,004.17
  100-199% FPL           822.59              942.77      1,765.36
  200-400% FPL         1,138.76            1,605.64      2,744.40
  > 400% FPL           1,548.98            2,146.62      3,695.60
Total sample           1,152.69              150.50      2,657.97

                  Mean Income ($)

Family income
  < 100% FPL         10,523.55
  100-199% FPL       27,010.37
  200-400% FPL       50,988.42
  > 400% FPL        109,251.40
Total sample         61,101.60

n = 4,531 families in total sample.

Data are weighted.

FPL, federal poverty level.

Table 3: Percent of Families with Out-of-Pocket Expenditures > 10% of
Family Income

                  Percent of Families Spending > 10% of Income on
                           Out-Of-Pocket Expenditures for

                  Health Services (%)    Premiums (%)    Total (%)
Family income
  < 100% FPL             19.1                 9.8          28.3
  100-199% FPL            5.8                11.5          22.2
  200-400% FPL            3.1                 6.4          14.8
  > 400% FPL              1.4                 2.1           6.3
Total sample              5.1                 6.4          15.0

n = 4,531 families in total sample.

Data are weighted.

FPL, federal poverty level.

Table 4: Multivariate Regression Results Examining Insurance Coverage
as a Predictor of Financial Burden for Families with Income < 200% FPL

                               Percent Change in OOP Expenditures per
                                      $1,000 Income (n = 1,840)

                              Excluding Premiums    Including Premiums
Public insurance for all
  members all year                  -17.3%                -2.2%
Private insurance for all
  members all year                  105% *               758% **
All members uninsured all
  year                               Ref                   Ref
Partial insurance coverage           46.2%               129% **
Mix of public and private
  insurance                          70.9%               353% **

* p < .05;
** p < .001.

Controlling for family size, race/ethnicity, education, region,
residence in a metropolitan statistical area, health status, and
limitation of activity.

Data are weighted.

OOP, out-of-pocket; FPL, federal poverty level.