Methodological Biases in Estimating the Burden of Out-of-Pocket Expenses

Published in: Health Services Research, v. 35, no. 6, Feb. 2001, Commentary, p. 1357-1370

Posted on RAND.org on December 31, 2000

by Dana P. Goldman, James P. Smith

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In a recent issue of Health Services Research, Gross, Alecxih, Gibson, et al. (1999) (hereafter referred to as Gross et al.) argued that out-of-pocket health care expenses impose a substantial burden on the elderly, especially the poor elderly. They find that the elderly spend 19 percent of their income on medical care and, more importantly, that the average share rises to 35 percent for the poor elderly. Their estimates are based on simulations from the 1993 Medicare Current Beneficiary Survey (MCBS) but are similar to estimates by Moon, Kuntz, and Pounder (1996) from the 1987 National Medical Expenditure Survey using the same methodology. Gross et al. conclude from these results that Congress should increase the financial protection against high out-of-pocket expenses for the elderly. Unfortunately, the methodology used by Gross et al. substantially overstates the true burden of out-of-pocket health care expenses for the elderly, and this overstatement is particularly large for the poor elderly. Their approach also distorts the real policy issues that exist in providing elderly Americans adequate protection against the possibility of significant medical expenses during their old age. In this commentary, the authors describe the source and degree of the biases that exist in their research methodology.

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