Online Program

$100 versus $10,000: The timing of the great recession and heterogeneous changes along the health expenditure distribution

Tuesday, November 5, 2013 : 4:50 p.m. - 5:10 p.m.

Jie Chen, PhD, Department of Health Services Administration, School of Public Health, University of Maryland, College Park, College Park, MD
Arturo Vargas-Bustamante, Department of Health Services, UCLA School of Public Health, LA, CA
Karoline Mortensen, PhD, Health Services Administration, University of Maryland, College Park, MD
Stephen Thomas, PhD, FAAHB, Department of Health Services Administration, Center for Health Equity, University of Maryland School of Public Health, College Park, MD
Background: The Great Recession of 2007-2009 was the longest recession in the United States history. It has been associated with reduced health care spending among adults. The objectives of this study are: (1) To examine whether the Great Recession was linked to health expenditures and whether this association varied across the health spending distribution. (2) To examine whether racial and ethnic disparities in health care expenditure reduced, persisted or deteriorated during the recession across the expenditure distribution. Method: We employ nationally representative data from the Medical Expenditure Panel Survey of 2005-2006 and 2008-2009. Our outcome variables are annual health care expenditures: total health care spending, and spending on different types of health care services, i.e. physician visits, prescription drug, outpatient visit, inpatient visits, and emergency department (ED) visit. Quantile regressions are employed to estimate the different associations between the Great Recession and health care expenditure variation across the distribution of health care expenditures. Samples: Our analyses include adults aged 18 to 64 years old in the civilian, noninstitutionalized population Results: The Great Recession was significantly associated with reduced health care expenditures, but not at the upper levels of spending. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction of health care expenditure was similar for all race/ethnic groups. The Great Recession was associated with significant decreases in prescription drug spending, and it was associated with higher physician expenditures at the 50th percentile and above. The Recession was significantly positively associated with ED costs. The negative association of recession and health care expenditure was more substantial among the uninsured, followed by those with public and private health insurance. Conclusion: The economic recession was associated with a reduction in health expenditure, particularly in lower ends of the health care expenditure distribution, suggesting the possible deterioration in health care access and primary care utilization induced by the recession, especially among people without health insurance. Our study found no reduction in health expenditures among those requiring large amount of health care resources. Prescription drug cost reduction might indicate the likelihood of substituting generic drugs for expensive brand name ones, especially among the racial and ethnic minorities. Higher ED costs and increased physician expenditures during the Great Recession may be related to delays seeking primary care and resilience of physician's pay to economic crises, respectively. Racial and ethnic disparities persisted during the recession.

Learning Areas:

Diversity and culture
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Assess whether the Great Recession was linked to health expenditures and whether this association varied across the health spending distribution Investigate health expenditure variation between lower expenditure levels (proxy for health care access or preference for preventive care) compared to higher expenditure levels (proxy for intensiveness or quality of care) Demonstrate whether racial and ethnic disparities in health care expenditure reduced, persisted, or deteriorated during the recession across the expenditure distribution

Keyword(s): Health Care Access, Healthcare Costs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a health economist and health services researcher. My research focuses on health disparity, health outcome, and quantitative analysis. My Her health disparity research focuses on identifying and quantifying the factors associated with the disparities in health care access, utilization and expenditure among different racial and ethnic groups and immigrants in the United States. My research on health policy focuses on investigating the efficiency and quality of the health care delivery system.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Maryland Population Research Center policy faculty affiliation

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.