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February 2010, Vol. 133, No. 2
Out-of-pocket health care expenditures: a comparison
Ann C. Foster
Ann C. Foster is an economist in the Division of Consumer Expenditure Surveys, Office of Prices and Living Conditions, Bureau of Labor Statistics. E-mail: email@example.com
An examination of aggregate out-of-pocket health care expenditures from the CE, MEPS, and the NHEA for the 1996–2006 period indicates that methodological differences account for the lack of agreement among estimates.
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Tealth care expenditure data produced by the Federal Government come from a variety of data sources, including the Bureau of Labor Statistics (BLS) Consumer Expenditure Survey (CE), the household component of the Medical Expenditure Panel Survey (MEPS-HC) of the Department of Health and Human Services (DHHS) Agency for Healthcare Research and Quality, the National Health Expenditure Accounts (NHEA) of the DHHS Centers for Medicare and Medicaid Services, and the Personal Consumption Expenditures (PCE) of the Bureau of Economic Analysis (BEA). The purpose of this article is to examine annual aggregate CE, MEPS, and NHEA out-of-pocket health care expenditures for comparable categories from 1996 to 2006 to determine whether they are consistent across the three data sources.1
The CE collects information about out-of-pocket spending on health care and other expenses from consumer units2 throughout the United States. The MEPS-HC collects nationwide data on the cost and use of health care and on health insurance coverage at the household and the individual level.3 The NHEA are the official estimates of total health care spending in the United States. The NHEA measure aggregate annual expenditures for health care goods and services, public-health activities, program administration, and research and other investment related to health care, as well as the net cost of private insurance. The PCE measure the market value of health care and other goods and services purchased by the "personal sector" of the U.S. Census Bureau’s National Income and Product Accounts. Data for the NHEA and the PCE are obtained from secondary sources. Although health insurance premiums are a major part of household health care spending, they will not be examined in this article because the MEPS data that were used did not provide the information needed for the research undertaken.
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1 CE data have been regularly compared with estimates from other sources to check for consistency. Because the PCE have been a major source of independent data for comparison, PCE data are not used in this article. For more information, see "Consumer Expenditure Survey compared with Personal Consumption Expenditures," in Consumer Expenditure Survey, 2004–2005, Report 1008 (Bureau of Labor Statistics, October 2008), pp. 6–11, on the Internet at www.bls.gov/cex/twoyear/200405/csxtwoyr.pdf (visited Feb. 22, 2010); Thesia I. Garner, George Janini, William Passero, Laura Paszkiewicz, and Mark Vendemia, "The CE and the PCE: a comparison," Monthly Labor Review, September 2006, pp. 20–46, on the Internet at www.bls.gov/opub/mlr/2006/09/art3full.pdf (visited Feb. 22, 2010); and Clinton P. McCully, Brian C. Moyer, and Kenneth J. Stewart, "A Reconciliation between the Consumer Price Index and the Personal Consumption Expenditures Price Index" (Bureau of Economic Analysis, September 2007), on the Internet at www.bea.gov/papers/pdf/cpi_pce.pdf (visited Feb. 22, 2010).
2 A consumer unit is defined as (1) all members of a particular household who are related by blood, marriage, adoption, or some other legal arrangement, such as foster children; (2) a financially independent person living alone, sharing a housing unit with others, or living as a roomer in a private home, lodging house, or permanently in a hotel or motel; or (3) two or more persons living together who pool their incomes to make joint expenditures. For more information, see BLS Handbook of Methods (Bureau of Labor Statistics, April 2007), chapter 16, "Consumer Expenditures and Income," on the Internet at www.bls.gov/opub/hom/pdf/homch16.pdf (visited Feb. 22, 2010).
3 MEPS also has an insurance component (MEPS-IC), which is a separate survey of employers that provides data on employer-based health insurance. For more information, see "Medical Expenditure Panel Survey: Insurance/Employer Component" (U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Oct. 17, 2008), on the Internet at www.meps.ahrq.gov/mepsweb/survey_comp/Insurance.jsp (visited Feb. 22, 2010).
CE and the PCE: a comparison, The.—Sept. 2006
Household liability data in the Consumer Expenditure Survey.—Dec. 2009
Impact of income imputation in the Consumer Expenditure Survey, The.—Aug. 2009
Trends in out-of-pocket spending on health care, 1980-92.—Dec. 1995
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