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The National Academies of Sciences, Engineering and Medicine
Committee on National Statistics
Division of Behavioral and Social Sciences and Education

Measuring Medical Care Risk in Conjunction with
the New Supplemental Income Poverty Measure


MCER cover 






In 1995, a panel of the National Research Council (NRC) in Measuring Poverty: A New Approach recommended a new poverty measure, which compares families’ disposable income to poverty thresholds based on current spending for food, clothing, shelter, utilities, and a little more. The panel also recommended that the federal government develop a separate measure of medical care risk that would track the economic risk to families and individuals of lacking adequate health insurance coverage.

In response to a request from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services (HHS), the NRC’s Committee on National Statistics (CNSTAT), in collaboration with the Board on Health Care Services (HCS) of the Institute of Medicine, appointed a nine-member panel of experts. The panel conducted a study including a workshop with the goal of moving forward toward developing measures to inform policy that are feasible to collect and estimate and that will monitor changes in medical care economic risk and burden as health care reform is implemented and other relevant public and private sector changes occur. On the basis of the workshop discussions and its own review and deliberations of the issues, the panel developed conclusions and recommendations in five areas: (1) concepts of medical care economic burden and risk, (2) concepts of resources, (3) measurement of medical care economic risk, (4) data sources, and (5) development and implementation of the panel’s proposed measures.



Workshop on Developing a Measure of Medical Care Economic Risk


September 8, 2011





Agenda and List of Presenters




(Please note that the presentations included here may be subject to copyright restrictions of the individual presenters.)

Goal/Objectives of the Workshop:
The goal of the workshop will be to critically examine the state of the science in the development and implementation of a new measure of medical care risk, defined as the risk of incurring high out-of-pocket medical care expenses (including insurance premiums) relative to income. Such a measure needs to be feasible to implement with data that are available or likely to become available in the near future. Its purpose is to serve a monitoring function by reflecting changes in medical care economic risk that are attributable to implementation of health care reform and other factors.

Workshop participants will examine:
- Concepts of medical care economic risk, examining retrospective and prospective measures of risk;
- Issues surrounding the development of thresholds – variability of risk across populations including geographic variations in exposure to medical care economic risk, vulnerability of population groups including the insured, underinsured, and uninsured and those with chronic health conditions, acute catastrophic and non catastrophic conditions;
- Issues in defining resources – what is included in income in determining the ability to pay for insurance and for medical out-of-pocket expenditures (MOOP), how the self employed and different age groups pay for big expenses (assets, loans, free care).
- Implementation issues – data availability currently and prospectively, data quality concerns, timeliness concerns.



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