研究 不断变化的医疗保健市场中的财务和身体健康

11月1日标志着开放注册季节的开始, when millions of Americans take steps to choose the right healthcare plan for themselves and their families. Consumers will be making key decisions impacting both their financial and physical health amongst a changing healthcare market, 自费支出上升, 并就如何有效改革美国金融体系进行了现场讨论.S. 卫生保健系统. 记住这个背景, we reflect on 澳博官方网站app 研究所 research that informs these issues and provides insights into how families make choices around healthcare.

Our research on medical spending has explored the link between a family’s out-of-pocket healthcare expenses and the rest of their financial life. 根据我们的 医疗保健自付支出小组 (HOSP), 我们调查了自费医疗支出的财务压力, 额外医疗费用的经济负担, 以及现金流动态在促使消费者寻求医疗服务方面的作用. 当家庭考虑他们的保险选择时, 这对政策制定者很重要, 供应商, and 纳税人 to understand the relationship between out-of-pocket expenses and how and when consumers seek and pay for medical care.

我们的研究已经广泛地证明了这一点, families across the income spectrum tend to experience a high level of income and spending volatility on a month-to-month basis. 典型的家庭经历超过 收入和支出每月都有30%的波动. 我们估计每个家庭需要的液体缓冲是 六个星期的实得收入 为了抵御同时出现的收入下降和支出飙升. 但大多数家庭(65%)没有这样的财务缓冲. 此外, 自付医疗费用可能是费用波动和经济负担的主要来源. 尽管这个国家的大多数人91.5%)有健康保险, we find that one in six families (or 17 percent) make at least one extraordinary healthcare payment (more than $400 and roughly $2,(平均为1000人). Paying such a large out-of-pocket sum has long-term financial consequences; even twelve months after making an extraordinary payment, families’ had lower levels of liquid assets and higher revolving credit card balances compared to their pre-payment baseline.

事实上, 当家庭考虑他们的医疗保险选择时, 他们将在一个自付费用不断增加的环境中做出决定. 连续三年, 2014 - 2017年, 自付医疗保健支出水平加速至同比增长8%.2017年5%. 2017年的自付支出平均为625美元，医疗负担从1美元增加到1美元.2016年税后收入的6%降至1%.2017年7%. 每个州和人口群体的医疗保健支出都在增长. 这一趋势没有放缓的迹象, with the continued growth of high-deductible plans amidst significant support from regulators and 纳税人 guided by the belief that consumer cost accountability will rationalize healthcare utilization. 

在经历了普遍的家庭财务波动和不断增长的自付费用之后, families will make a tactical choice during open enrollment season: selecting a health insurance plan. 我们的研究提供了一些见解，可以指导消费者做出这个复杂的决定. 第一个, it is important to realize that the choice of what insurance plan is right for a family really does depend on their circumstances. 这是因为医疗支出难以置信地集中在一小部分家庭中. The top 10 percent of spenders—those families most financially burdened by out-of-pocket healthcare expenses—spent on average $3,255, 哪个是平均消费的5倍，代表9.税后收入的5%.

此外, those with high out-of-pocket costs in one year are likely to have similar costs in the subsequent year. 从这个意义上说，医疗成本是粘性的, 那些医疗费用高的人可能知道他们是谁. 例如, 妇女的医疗支出负担高于平均水平, 这意味着他们在医疗保健上的支出占收入的比例更高，约为2%. 一般来说, families with high healthcare spending may be better off in a plan with a low deductible and broader coverage. Families with low out-of-pocket healthcare spending may consider opting into a high-deductible plan if it has a lower insurance premium.

Families also need to think about their choice of health insurance as having direct implications for their savings behavior. 我们倾向于将储蓄目标与健康保险计划的选择分开考虑, 但我们应该准备的最重要的事情之一是我们的健康, 通过为我们可能陷入困境的自付医疗费用存钱. 事实上, 我们在数据中观察到，流动资产在医疗保健利用中起着关键作用, 医疗支出与现金流有着错综复杂的联系. 医疗保健 spending spikes in months when a family has higher-than-average liquid assets and income; for example, 我们观察到退税引发的支出. 在退税到达后的一周内, 自付医疗费用增长60%. 这一增长的62%用于亲自护理, 而不是过去的医疗费用. 因此, 当人们有钱的时候，他们通常会去看医生, 不一定是他们真正需要照顾的时候, 哪些最终会对健康产生负面影响.

Families with cash reserves are better able to weather a medical expense than their counterparts without such savings and are less likely to defer health expenses until after their tax refund arrives, 这强化了一个事实，即医疗支出与现金流有着错综复杂的联系. 鉴于现金缓冲在应对意外支出方面的重要性, 评估健康保险计划时, families ought to consider whether they have a sufficient financial buffer and the risk appetite to cover their deductible and maximum out of pocket costs stipulated by each plan option. 选择高免赔额计划时, families should strongly consider opening and contributing to a Health Reimbursement Accounts (HRAs) or 医疗保健 Savings Account (HSAs), 哪些是为短期和长期医疗需求储蓄的节税方式. 不管家庭是否有HRAs或HSAs, 他们应该采取措施建立足够的现金缓冲来支付免赔额, 因为那是, 实际上, 家庭自行投保的金额.

鉴于家庭在自费医疗费用方面面临的挑战， 政策制定者, 雇主, 纳税人, and 供应商 all have a role to play in helping families make better decisions regarding their healthcare. 应对这些挑战的方法有很多, 特别是, 它们可以帮助消费者管理成本, 增加透明度, 降低价格. 

• 增加竞争和选择，降低医疗保健价格，提高价格透明度. The geographic view of our data shows high variation in out-of-pocket healthcare spending and burden levels across states and counties. 例如, 犹他州和科罗拉多州的平均支出水平最高, 分别为864美元和797美元, 而西弗吉尼亚州的平均消费水平最低，为495美元. 我们在县一级进行的更细致的分析表明，即使在州内也是如此, 医疗支出和负担水平各不相同. 例如, we see in California that families in some counties have healthcare spending burdens as high as 2.56%在马林县, 而其他地区的自付支出负担较低，比如帝国县(Imperial County)的自付支出为0.94%. 因此, there is both variability in cost across geographies—but also a sense of uncertainty that consumers face around expected costs. Many families usually don’t know their out-of-pocket liability until after they receive a statement from their provider or benefits explanation from their insurer. 这使得家庭很难比较价格或“货比三家”购买医疗服务, 更不用说计划开支了, 或者平衡他们的短期和长期需求.
  
  努力减轻这种可变性, 但仍然鼓励选择，同时保持低成本包括(1)降低药品价格, and (2) creating price transparency for healthcare goods and services prior to the point of care to avoid surprise bills. Bringing transparency to the price of health care and disclosing out-of-pocket costs can enable consumers to make healthcare choices 之前 接受照顾，防止意外和无法管理的费用带来不必要的负担. 通过努力改善信息获取，提供者也可以在这方面发挥作用, 协助消费者规划, 简化账单. 简化账单可以提高消费者的透明度和理解力.

• 帮助消费者管理成本 扩大医疗报销账户(HRA)和医疗储蓄账户(HSAs)的使用范围. The theory goes that if consumers have “skin in the game” they will have an incentive to contain their costs and only seek high-value care. 但他们需要有人帮助他们为这些费用储蓄, and a series of efforts are underway to expand access to tax advantaged accounts to do just that. 然而，它们也引入了一套新的不容易解决的财务决策. Consumers may face a choice to save pre-tax dollars for health alone that can roll over year-to-year, 灵活储蓄账户中的税前美元，如果不使用就会丢失, 或者税后的钱可以随时花掉，而且永远不会丢失. 决定哪一个选择是正确的是很有挑战性的. 这些并发症成为吸收和利用的障碍. 另外, 并不是每个人都可以使用HRAs和HSAs, further contributing to heterogeneity in the way consumers prepare for and experience healthcare expenses.

不管即将出台的潜在政策建议是什么, the decision during open enrollment is fundamentally a personal one; and our data suggest, it is a financial decision that should be considered in the broader context of one’s financial life. 考虑到一个人应该为医疗费用存多少钱的直接影响, making an informed decision will help to ensure not only one’s financial health but also physical health.