Volume 44 | Number 3 | June 2009

Abstract List

Thomas M. Selden


To examine the within‐year concentration of family health care and the resulting exposure of families to short periods of high expenditure burdens.

Data Source

Household data from the pooled 2003 and 2004 Medical Expenditure Panel Survey (MEPS) yielding nationally representative estimates for the nonelderly civilian noninstitutionalized population.

Study Design

The paper examines the within‐year concentration of family medical care use and the frequency with which family out‐of‐pocket expenditures exceeded 20 percent of family income, computed at the annual, quarterly, and monthly levels.

Principal Findings

On average among families with medical care, 49 percent of all (charge‐weighted) care occurred in a single month, and 63 percent occurred in a single quarter). Nationally, 27 percent of the study population experienced at least 1 month in which out‐of‐pocket expenditures exceeded 20 percent of income. Monthly 20 percent burden rates were highest among the poor, at 43 percent, and were close to or above 30 percent for all but the highest income group (families above four times the federal poverty line).


Within‐year spikes in health care utilization can create financial pressures missed by conventional annual burden analyses. Within‐year health‐related financial pressures may be especially acute among lower‐income families due to low asset holdings.