Underinsurance for healthcare among working age adults

BACKGROUND: Working-age adults account for 51% of personal healthcare spending. These individuals financed approximately 18% of the healthcare spending out-of-pocket. Falling private insurance coverage and restrictions in coverage have contributed to high out-of-pocket spending by this group. Out-of-pocket spending is increasing even for fully insured families. Thus, underinsurance in this population may adversely affect their health and standard of living.

OBJECTIVE: Evaluate underinsurance for healthcare spending among working-age adults and examine subgroups which are at risk for underinsurance.

METHODS: Cross-sectional data (2005) on 13,186 individuals aged between 22 and 62 with positive total healthcare expenditures from the annual Medical Expenditure Panel Survey. Underinsurance for healthcare is defined as proportion of out-of-pocket spending to total healthcare expenditures. This was categorized into 6 groups: 1) under 5%; 2) 5-10%; 3) 10-20% 4) 20-40%; 5) 40 – 75% and 6) above 75%. Chi-square tests and multionomial logistic regressions were used to examine identify individuals at risk for underinsurance. In multionomial logistic regression, those who spent less that 5% of the total expenditures out-of-pocket were used as the reference group. The independent variables were gender, race/ethnicity, age, living with spouse/partners, region, metro area, insurance coverage, education, employment, household poverty level, usual source of care, perceived physical and mental health status, disability status, and chronic physical and mental illnesses. All analyses accounted for the complex design of MEPS.

FINDINGS: Overall, 14% had less than 5% total expenditure spent out-of-pocket; 61% reported spending 20% or more of total healthcare expenditures out-of-pocket. Women were more likely to be underinsured. Adjusted odds ratio for women spending 60-75% of total healthcare expenditures out-of-pocket was 1.40 with 95% CI = 1.21, 1.60. Similarly, individuals in the age group 50-61 were more likely to be underinsured. The adjusted odds ratios ranged from 1.77 to 2.54. Those living with spouse were less likely to experience underinsurance. The adjusted odds ratios ranged from 0.66 to 0.81. Being employed did not guarantee protection against underinsurance. Individuals with mental illness compared to those without mental illness were more likely to be underinsured.

CONCLUSION: Rates of underinsurance among working-age individuals were high. Some subgroups of individuals were vulnerable and at greater risk for underinsurance.

IMPLICATION: Insurance coverage expansions alone are not enough to reduce out-of-pocket spending and underinsurance among working-age adults. Given that individuals with high out-of-pocket spending are likely to forego needed services, these individuals are also at high-risk for high healthcare spending due to illnesses.