Out-of-Pocket Health Spending between Low- and High-Income Populations: Who is at Risk of Having High Financial Burdens?

We examined characteristics of people with little, moderate, and high burden of out-of-pocket health spending separately for low-income (below 200% of Federal Poverty Line) and higher-income populations. We find that public insurance appears to offer the best financial protection against high out-of-pocket burden. People with private non-group coverage, regardless of their income levels, have the highest risk of being exposed to high out-of-pocket burden. Low-income adults with employer-sponsored insurance are also more likely to be in high burden group than the low-income uninsured adults. For higher-income families, having a family member in fair or poor health is another significant risk factor to increase the likelihood of high out-of-pocket burden. Increasing presence of HMO and Federally Qualified Health Centers appear to have lowered the odds of being in the high-burden category relative to low-burden category, especially for the low-income group.