National estimates of health care expenditure burdens among the nonelderly population with depression: 2002 - 2006

Context: Policymakers and clinicians need to understand the high health care costs families face due to depression, a common medical condition and the leading cause of disability. Objective: To examine high out-of-pocket financial burdens among the nonelderly population with depression using nationally representative data. Design, Setting, and Population: Data from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys (2002-2006) were used to examine the risk of high health care expenditure burdens among people with depression. Main Outcome Measures: We construct two measures of burden. Health care service burden is the share of family-level income spent on out of pocket expenditures on health care services. Total burden is the share of family-level income spent on health care services and health insurance premiums. We define high burdens using two thresholds, health care spending equal to or greater than 10% and 20% of income. Results From 1996 to 2006, the risk of high health care service burdens (spending more than 10% of income) among persons with depression rose from 19.9 percent to 25.4 percent while the risk of high burdens among persons without depression rose from 10.6 percent to 13.1 percent. Using pooled data from 2002-2006, we examined total burdens by insurance status, treatment type and presence of other medical conditions. Persons with depression are twice as likely to have high burdens compared to those without depression (31.9 percent vs. 15.0 percent) Persons with depression with nongroup insurance have the highest risk of high burdens (72.5%). Persons receiving both psychotherapy and pharmacotherapy (36.5%) have higher burdens compared to those receiving psychotherapy only (21.5 percent) and pharmacotherapy only (32.4 percent). Persons with at least one other medical condition are significantly more likely to have high burdens compared to those with depression only (38.4% vs. 23.6%). Conclusions: Persons with depression are more likely to have high financial burdens than persons without depression. Among those with depression, burdens are higher among those with nongroup insurance, those receiving combination therapy for depression and those with other chronic conditions.