研究 Financial and Physical Health in a Changing 医疗保健 Market

11月1日标志着开放注册季节的开始, 当数以百万计的美国人为自己和家人选择合适的医疗计划时. 在不断变化的医疗保健市场中，消费者将做出影响其财务和身体健康的关键决定, 自费支出上升, and live discussions on how to effectively reform the U.S. 卫生保健系统. 记住这个背景, 我们对12bet官方研究所的研究进行了反思，这些研究为这些问题提供了信息，并为家庭如何在医疗保健方面做出选择提供了见解.

我们对医疗支出的研究探讨了家庭自付医疗费用与他们其余财务生活之间的联系. 根据我们的 医疗保健自付支出小组 (HOSP), we have investigated the financial pressures of out-of-pocket healthcare spending, the financial burden of extraordinary medical payments, and the role of cash-flow dynamics in enabling consumers to seek medical care. 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, 以及支付者了解自付费用与消费者如何以及何时寻求和支付医疗保健之间的关系.

我们的研究已经广泛地证明了这一点, 在每个月的基础上，不同收入阶层的家庭往往会经历收入和支出的高度波动. 典型的家庭经历超过 30 percent swings on a month-to-month basis in both income and spending. 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 in order to weather a simultaneous income dip and expense spike. But most families—65%—do not have such a financial buffer. 此外, out-of-pocket medical expenses can be a key source of expense volatility and financial burden. 尽管这个国家的大多数人91.5%)有健康保险, 我们发现，六分之一的家庭(或17%)至少支付了一笔特殊的医疗费用(超过400美元，大约2美元),(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, 与预付基准相比，家庭的流动资产水平较低，信用卡循环余额较高.

事实上, as families consider their options for healthcare coverage, they will be making decisions in an environment of increasing out-of-pocket costs. 连续三年, 2014 - 2017年, out-of-pocket healthcare spending levels accelerated to a year-over-year growth rate of 8.2017年5%. 2017 out-of-pocket spending was $625 on average, and the healthcare burden increased from 1.2016年税后收入的6%降至1%.2017年7%. Growth in healthcare spending occurred across every state and demographic group. 这一趋势没有放缓的迹象, 随着高免赔额计划的持续增长，在监管机构和支付者的大力支持下，消费者成本问责制将使医疗保健利用合理化. 

Amid experiences of general household financial volatility and growing out-of-pocket costs, 家庭将在开放注册季节做出战术选择:选择健康保险计划. Our research provides insights that can guide consumers as they navigate this complex decision. 第一个, 重要的是要认识到，选择哪种保险计划对一个家庭来说是正确的，确实取决于他们的情况. This is because healthcare spending is incredibly concentrated among a small group of families. 最富有的10%的家庭——那些被自付医疗费用负担最重的家庭——平均花费3美元,255, which is five times as much as the average spender and represents 9.税后收入的5%.

此外, 那些在某一年自付费用高的人在接下来的一年可能会有类似的费用. 从这个意义上说，医疗成本是粘性的, and those with high healthcare costs probably know who they are. 例如, women experience higher than average healthcare spend burdens, meaning they spend more on healthcare as a share of their income—about 2 percent. 一般来说, 医疗支出高的家庭如果选择免赔额低、覆盖范围广的保险计划可能会更好. 自费医疗费用较低的家庭可能会考虑选择高免赔额计划，如果它的保险费较低的话.

家庭还需要考虑他们对健康保险的选择是否会直接影响他们的储蓄行为. We tend to think about our savings goals as separate from our choice of health insurance plan, but one of the most important things we should be provisioning for is our health, by saving for the out-of-pocket healthcare expense we might be on the hook for. 事实上, we observe in the data that liquid assets play a key role in healthcare utilization, and healthcare spending is intricately linked to cash flows. 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, out-of-pocket healthcare payments increased by 60 percent. 这一增长的62%用于亲自护理, rather than for healthcare bills for care received in the past. 因此, people often seek medical care when they have the money to pay for it, 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.

有现金储备的家庭比没有现金储备的家庭更有能力支付医疗费用，而且不太可能将医疗费用推迟到退税到来之后, reinforcing the fact that healthcare spending is intricately linked to cash flows. Given the importance of a cash buffer in weathering an unexpected expense, 评估健康保险计划时, 家庭应该考虑他们是否有足够的财务缓冲和风险偏好来支付每个计划选项规定的免赔额和最高自付费用. 选择高免赔额计划时, 家庭应该强烈考虑开设医疗报销账户(hra)或医疗储蓄账户(HSAs)并向其缴款。, which are tax efficient ways to save for short- and long-term healthcare needs. Regardless of whether families have access to HRAs or HSAs, they should take steps to establish a cash buffer sufficient to cover the deductible, 因为那是, 实际上, 家庭自行投保的金额.

In light of the challenges families have with out-of-pocket healthcare expenses, 政策制定者, 雇主, 纳税人, 在帮助家庭做出更好的医疗保健决定方面，医疗服务提供者都有责任发挥作用. There are a number of approaches to address these challenges, 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. 

• Increase competition and choice, reduce healthcare prices, and improve price transparency. 我们数据的地理视图显示，各州和县的自费医疗支出和负担水平差异很大. 例如, Utah and Colorado had the highest average spending levels, 分别为864美元和797美元, while West Virginia had the lowest average spending level at $495. Our even more granular analysis at the county level illustrates that even within states, there is variation within healthcare spending and burden levels. 例如, 我们在加州看到，一些县的家庭医疗支出负担高达2美元.56%在马林县, while others have lower out-of-pocket spending burdens like Imperial County at 0.94%. 因此, 不同地区的成本存在差异，但消费者面临的预期成本也存在不确定性. 许多家庭通常不知道他们的自付责任，直到他们收到他们的提供者的声明或保险公司的福利解释. This makes it difficult for families to compare prices or “shop around” for healthcare services, 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, but still encourage choice while keeping costs low have included (1) reducing drug prices, (2)在护理点之前为医疗保健产品和服务建立价格透明度，以避免意外账单. 提高医疗保健价格的透明度并披露自付费用，可以使消费者做出医疗保健选择 之前 receiving care and prevent undue burden from unexpected and unmanageable expenses. Providers also have a role to play here through efforts to improve access to information, 协助消费者规划, 简化账单. Simplifying billing can improve transparency and understanding for consumers.

• 帮助消费者管理成本 by expanding access to Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSAs). 该理论认为，如果消费者“参与其中”，他们将有动力控制自己的成本，只寻求高价值的医疗服务. 但他们需要有人帮助他们为这些费用储蓄, 为了实现这一目标，政府正在采取一系列措施，扩大使用税收优惠账户的渠道. However, they also introduce a new set of financial decisions that are not easy to resolve. 消费者可能会面临一个选择，那就是把税前的钱只存到医疗上，然后逐年滚动, pre-tax dollars in a flexible savings account which is lost if not used, or post-tax dollars to be spent whenever and will never be lost. It’s challenging to determine which choice is the right one. These complications serve as barriers to take-up and utilization. 另外, 并不是每个人都可以使用HRAs和HSAs, 进一步导致消费者准备和体验医疗费用的方式存在差异.

Regardless of potential policy proposals on the horizon, the decision during open enrollment is fundamentally a personal one; and our data suggest, 这是一个财务决策，应该在一个人的财务生活的更广泛的背景下考虑. Given the direct implications for how much one should save in reserve for medical expenses, 做出明智的决定不仅有助于确保一个人的财务健康，也有助于确保身体健康.