Rationalization of health services: political and social assumptions.
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Dismissed as a luxury only for the young or wealthy, medical savings accounts could be used by a majority of Americans--who are neither poor or chronically ill--to make cost-conscious choices about their health care. Current federal tax laws and insurers' inability to sell catastrophic group coverage policies pose obstacles to their widespread use and should be removed.
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Stop-loss insurance can provide protection from catastrophic medical claims for self-insured companies: But buyer beware.
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Proposed federal legislation would expand the coverage options Medicare beneficiaries have. One option--Medisave--would enable beneficiaries to replace traditional Medicare coverage with a catastrophic insurance policy coupled with a medical savings account. At least initially, this risky insurance product is likely to appeal to only a small segment of the Medicare population.
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This article describes the characteristics of families with catastrophic health care expenditures. Based on data from a national sample, three overlapping groups of families are considered: those incurring annual out-of-pocket expenditures that exceed, respectively, 5, 10, and 20 percent of the family's income. Such families represent a small percentage of all families, but they account for a disproportionally large share of total health care expenditures. Nevertheless, the actual amounts spent out of pocket by most of these families are relatively small. Modest sums are financially burdensome to these families because they are more likely to be low-income and to be headed by someone who is not employed. Families with catastrophic expenditures are also more likely to be headed by someone 65 or older and, consistent with that, a greater share of their total expenditures is covered by Medicare. However, all other third-party payers cover a relatively smaller share of total expenditures for these families than they do for all families, reflecting the generally worse third-party coverage of families with catastrophic health expenditures. The implications of these findings for several current issues are discussed, including catastrophic coverage proposals for Medicare and proposed programs to help the medically indigent and the uninsured.