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2017年9月
每个人在一生中都会面临不同类型的财务挑战. 正如澳博官方网站app研究所所显示的那样, 收入 volatility drops with age while expense volatility remains high across the age spectrum (Farrell and Greig, 2017). Nearly four in ten families—particularly 年长的家庭—make an extraordinary payment related to health, 汽车修理, 以及某一年的税收, 可能难以预测的付款. 六分之一的家庭(16%)在任何一年都支付了超常的医疗费用, but families 65 years and older are about twice as likely as families under 30 years to have made an extraordinary medical payment.
Recent healthcare reform policy debates have focused on the degree to which families should be expected to shoulder the costs of healthcare services. 他们这样做的能力不仅与收入密切相关，还与年龄密切相关. 在这一点上, the 澳博官方网站app 研究所 compares the incidence of extraordinary medical payments and their impact on financial outcomes for different age groups.
Though the need to make major medical payments can occur across all age levels and increases over time, both the financial conditions of families and the resources they have to respond to such expenses differs among younger (18-29 years), 中年(30-64岁), 老年家庭(65岁以上). 基于近100个样本,从2013年到2015年, 澳博官方网站app 研究所 data show that younger and middle-aged families were more likely to make medical payments in months when they had higher 收入 and liquid assets. 然而, 年长的家庭, 谁的流动资产较高，收入波动较小, 没有强烈地证明这种模式吗. We also observed that there were many younger and 年长的家庭 who increased their revolving credit card debt after making major medical payments, 而且这些增长持续存在, 甚至成长, 在支付医疗费用后的12个月内.
关键的事实
基于2013年至2015年近10万个家庭的样本，我们观察到:
- 特别医疗费用的发生率和数额随着年龄的增长而增加.
- Younger families (18-29 years) had lower liquid assets and higher 收入 volatility and were much more likely than 年长的家庭 (65+ years) to make extraordinary medical payments in months when they had a higher ability to pay.
- 年轻家庭(18-29岁)和年长家庭(65岁以上), revolving credit card debt remained more than 10 percent higher relative to baseline a year after the medical payment.
- 在支付了一笔巨额医疗费用一年后, younger families (18-29 years) were most likely to have newly taken on revolving credit card debt, 而年龄较大的家庭(65岁以上)的债务增幅最大.
关于数据
澳博官方网站app研究所(澳博官方网站app 研究所)收集了96份去识别样本,在2013年至2015年期间，有5000名核心大通支票账户客户, for whom we could categorize at least 80 percent of expenses and who had ever made an extraordinary medical payment.1 为了我们的研究目的, 分析单元是主帐户持有人, 我们后来称他们为一家人. 我们根据主要账户持有人的年龄对家庭进行分组, recognizing that other account users or family members paid for through the account may have been of any age.2 评估对财务结果的影响, 我们关注的是55人的子样本,在2013年至2015年期间，有1万个家庭只支付了一笔特别医疗费用.
我们将每月至少400美元的医疗费用定义为“特殊”医疗费用, 超过年收入的百分之一, 而且与家庭月平均医疗费用相差两个标准差以上.3 These three criteria ensured that the magnitude of the medical payment was both large and unusual, 因此特别, 对于每个家庭来说. We examined changes in families’ overall financial behavior that coincided with an extraordinary medical payment relative to a baseline period between four and six months prior to the medical payment.4 我们将在下面描述我们的关键见解.
影响
在生命周期中，家庭对特殊医疗费用的反应是不同的. 我们的分析表明，年轻的家庭, 谁的流动资产更少，收入波动更大, 他们的医疗费用与收入和流动资产的增加同步. 对于年龄较大的家庭来说，医疗账单更为常见和频繁. 然而，他们的确切时间和数量仍不确定. 年龄较大的家庭收入波动较小，流动资产较多, 为了支付一大笔医药费，他们往往会取出这笔钱. Still, for both groups, there were many families who turned to revolving credit card debt to cope. Revolving credit card debt remained elevated a year after the medical payment among both younger and 年长的家庭, 年轻家庭的信用卡债务增幅最大. This increased revolving credit card debt could be particularly challenging for 年长的家庭, 因为他们往往有较低的收入来减少信用卡债务.
These findings support the need for more effective financial solutions to help younger and 年长的家庭 weather health-related financial shocks. 这些解决方案可以帮助家庭建立一个 日常现金缓冲, potentially through employer-sponsored pre-tax health reimbursement accounts or other “side-car” savings accounts, to allow families to pay for medical services when they need them without having to rely on 收入 and asset spikes or credit card debt.
Additionally consumers might benefit from better tools and payment options to help families anticipate and manage their medical expenses. 病人应该能看清楚, 在费用发生时或发生之前对其医疗保健费用的准确估计. 当账单到达时，他们可能会受益于灵活的付款方式, 包括短期和长期的融资选择, 还有按时付款的折扣. 长期规划和管理医疗费用, consumers might be well served by more integrated tools that help consumers shop around for non-emergency care and put their medical-related account balances, 账单, 付款都在一个地方.
Better understanding the incidence and impacts of major medical expenses among the young and the old is critical to designing effective solutions tailored to the needs of families in different life stages.
建议引用
法雷尔，戴安娜，格雷格，菲奥娜. "终生应对医疗费用.澳博官方网站app研究所，2017年.
1.本文中使用的样本是大约250个样本中的一个子集,《澳博体育app》中使用的5000个家庭(2017年), 谁的支票账户每个月至少有五次资金流出, 在信用局有记录吗, 每月至少使用一次借记卡或信用卡, 通过无法分类的渠道花费的费用不超过总费用的20%, (e.g. 检查, 现金, 支付给未观察到的信用卡, 和其他未分类的电子渠道), 在2013年至2015年期间，每年至少支付一笔住房款. Observations in this sample were weighted to match the age and 收入 distribution of the US population in 2014.
2.在我们的样本中，67%的账户拥有多个授权用户, 33%的主要账户持有人是个人账户持有人. 每个帐户的平均授权用户数为1.66户，低于全国家庭规模2户.2014年美国社区调查(ACS), due to the fact that authorized users are typically adults whereas ACS household size would include children. It may also be the case that some families have multiple accounts with different individuals listed as the primary account holder.
3.We used $400 as a minimum threshold in order to provide some comparability between our measure of extraordinary payments and the 2015 Survey of Household Economic Decision making (Board of Governors of the Federal Reserve System, 2016). We allowed for this minimum threshold to scale with 收入 in order to account for higher costs of services typically consumed by high-收入 families as well as to ensure that we were examining an extraordinary payment that would be material in magnitude across the 收入 spectrum. 在总, 额外的医疗支付金额包括看医生(19%), 救护车和医院(13%), 牙科(36%), 光学(8%), 医疗设备(7%), 其他医疗服务(15%), 处方药(1%). 标准差是用所有36个月来计算的，包括没有付款的月份.
4.2013年至2015年, 收入, 非医疗费用, 月末流动资产, 循环信用卡债务也大幅增加(每年占收入的8%), 每年5%的非医疗费用, 流动资产每年11%, 以及每年6%的循环信用卡债务). 为了解释这种增长，我们从这些时间序列中去掉了这些长期趋势. See Farrell and Greig (2017) for an in-depth discussion of each of the de-trending procedures used to adjust for secular trends.
5.图3代表了至少支付了一笔主要医疗费用的家庭. 当看到所有的家庭, 收入和流动资产较低, 这表明已经有选择发生在家庭支付这些钱的情况下.
6.第0个月是支付特别医疗费用的月份. 基准期是指付款月之前的4至6个月.
