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.
Economic insecurity has been a hallmark of the last decade making many families vulnerable to income, employment, and health insurance losses. Such economic shocks can have a profound effect on a family's health security. This analysis will provide a unique perspective on how family health care decision making responds to realized or anticipated changes in economic circumstances, and whether public policy, including the Affordable Care Act, can effectively address the threat to health security from such economic shocks.
