Economic Shocks and Family Health Security

 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做出艰难的支出选择。随着家庭努力保持他们的生活水平， 关于医疗保健使用的决定可能会变得更加自由和复杂。特别是，经历经济冲击的家庭可能被要求在家庭成员和特定的医疗服务中优先考虑他们的医疗支出。该项目将审查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的分配以及自付支出负担如何对其经济地位的已实现和预期变化作出反应。经济地位的实际变化是通过观察到的家庭收入、就业和医疗保险方面的损失来衡量的。考虑到这些观察到的家庭经济安全属性的变化，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，这可能会影响家庭对未来经济前景的预期。这项研究的概念基础是基于家庭中的利他主义的家庭内部资源分配决策的经济模型。该分析将使用2004-2012年医疗支出小组调查家庭部分的小组数据，以衡量这些经济冲击对两年观察期内家庭保健决策变化的影响。这些经济冲击的影响是通过包括分数响应模型在内的替代固定效应计量经济模型来评估的。这些模型解释了未观察到的、时不变的家庭特征，从而确定了在两年观察期内家庭内医疗保健支出的变化。这些经济冲击的影响是根据家庭特征来考虑的，例如父母的数量、收入和是否患有慢性病。这项分析为医疗决策如何应对家庭经济地位的变化，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医疗支出的影响提供了独特的视角。

 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.