Economic Shocks and Family Health Security

经济冲击与家庭健康保障

• 批准号: 9091425
• 负责人: Alan C Monheit
• 金额: $ 21.16万
• 依托单位: RBHS-SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9091425
• 关键词: Economic; Shocks; Family; Health; Security

 DESCRIPTION (provided by applicant): Financial insecurity resulting from negative economic shocks - losses of income, employment, and health insurance - can result in difficult spending choices by families on critical necessities. As families strive to preserve their living standards, decisions regarding health care use may become far more discretionary and complex. In particular, families experiencing an economic shock may be required to prioritize their health care spending among family members and specific health care services. This project will examine how the family's use of health services, specifically its total health care spending, allocation among family members and health services, and out-of-pocket spending burden, responds to both realized and anticipated changes in its economic status. A realized change in economic status is measured by observed losses in family income, employment, and health insurance. Accounting for changes in these observed attributes of family economic security, an anticipated economic shock is measured by the exogenous change in macroeconomic conditions which may affect the family's expectations regarding its future economic prospects. The conceptual basis for this study draws upon economic models of intra-family resource allocation decisions based on altruism in the family. The analysis will apply panel data from the Medical Expenditure Panel Survey Household Component for the years 2004 - 2012 to measure the impact of these economic shocks on changes in family health care decision making over two-year observation periods. The impact of these economic shocks is assessed through alternative fixed-effects econometric models including fractional response models. These models account for unobserved, time-invariant family characteristics so that within-family changes in health care spending over two-year observation periods are identified. The impact of these economic shocks is considered according to family characteristics such as number of parents, income, and the presence of a chronic illness. The analysis provides a unique perspective on how health care decision making responds to changes in family economic status and how public policy, such expanded Medicaid coverage and provisions of the Affordable Care Act, can lessen the impact of economic losses on family health spending.

 描述（由申请人提供）：负面经济冲击造成的财务不安全-收入，就业和医疗保险的损失-可能导致家庭在关键必需品上的支出选择困难。随着家庭努力维持他们的生活水平， 关于卫生保健使用的决定可能变得更加随意和复杂。特别是，经历经济冲击的家庭可能需要在家庭成员和特定医疗保健服务中优先考虑其医疗保健支出。本项目将研究家庭对保健服务的使用，特别是其保健总支出、家庭成员和保健服务之间的分配以及自付支出负担如何应对其经济状况中已实现和预期的变化。经济地位的实际变化是通过观察到的家庭收入、就业和健康保险的损失来衡量的。考虑到家庭经济保障的这些观察到的属性的变化，预期的经济冲击是通过宏观经济条件的外生变化来衡量的，这种变化可能影响家庭对其未来经济前景的预期。本研究的概念基础借鉴了经济模型的家庭内部资源分配的决定，在家庭中的利他主义。该分析将采用2004 - 2012年医疗支出小组调查家庭部分的面板数据，以衡量这些经济冲击对家庭医疗保健决策变化的影响，为期两年。这些经济冲击的影响是通过替代固定效应计量经济模型，包括分数响应模型进行评估。这些模型占未观察到的，时不变的家庭特征，使家庭内的变化，在两年的观察期内的医疗保健支出被确定。这些经济冲击的影响是根据家庭特点，如父母人数、收入和是否患有慢性病来考虑的。该分析提供了一个独特的视角，医疗保健决策如何应对家庭经济状况的变化，以及公共政策，如扩大医疗补助覆盖范围和《平价医疗法案》的规定，如何减轻经济损失对家庭健康支出的影响。