Health Spending For Low-, Middle- ,And High-Income Americans, 1963-2012
Health Spending For Low-, Middle- ,And High-Income Americans, 1963-2012
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DOI：
10.1377/hlthaff.2015.1024
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发表时间：
2016-07-01
期刊：
影响因子：
9.7
通讯作者：
Himmelstein, David U.
中科院分区：
文献类型：
--
作者：
Dickman, Samuel L.;Woolhandler, Steffie;Himmelstein, David U.
2004年至2013年间，美国医疗支出增长放缓。与此同时，许多美国人面临着不断上升的共同赔付和免赔额，这可能对低收入人群造成了特别大的影响。为了探索医疗支出放缓是否会平等地影响所有收入群体，我们将人口分为收入五分之一。然后，我们使用1963至2012年间进行的22项全国性调查，评估了每五分位数人群及其代表的医疗支出趋势。在1965年通过创建联邦医疗保险和医疗补助的立法之前，收入最低的五分之一人口的支出最低，尽管他们的健康状况比其他收入群体更差。到1977年，最低五分之一的未调整支出超过了所有其他收入群体的支出。这种模式一直持续到2004年。此后，收入最低的五分之一的支出下降，而收入最高的五分之一的支出增长了10%以上，收入最高的五分之一的支出增长了近20%，后者在2012年的支出最高。2004年后，富人、中产阶级和穷人的支出趋势分化只出现在非老年人中。我们的结论是，2004年后的新支出模式，最富有的五分之一人群在医疗保健上的支出最高，这表明随着医疗支出放缓，医疗保健向更富有的美国人重新分配。
US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles. We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012. Before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures, despite their worse health compared to other income groups. By 1977 the unadjusted expenditures for the lowest quintile exceeded those for all other income groups. This pattern persisted until 2004. Thereafter, expenditures fell for the lowest quintile, while rising more than 10 percent for the middle three quintiles and close to 20 percent for the highest income quintile, which had the highest expenditures in 2012. The post-2004 divergence of expenditure trends for the wealthy, middle class, and poor occurred only among the nonelderly. We conclude that the new pattern of spending post-2004, with the wealthiest quintile having the highest expenditures for health care, suggests that a redistribution of care toward wealthier Americans accompanied the health spending slowdown.