The Impact of Public Health Insurance on Financial Resources and Medical Expense Risk at Older Ages

Published: 2020
Project ID: UM20-10


We will estimate the total, Medicare, Medicaid, and out-of-pocket medical expenditures among the elderly across the income gradient. We will assess the risk of medical spending and how it is reduced through Medicaid and Medicare. We will also estimate the incidence of taxes paid to finance these programs and, thus, can calculate how much redistribution Medicaid and Medicare provide. We will then extend the analysis to other countries, including England. In doing so we can compare how medical spending risk in the U.S. compares with other countries. England’s health care system is in many ways similar to the U.S., as Medicare and the English National Health Service (NHS) cover most hospital expenditures but cover little of long-term care expenses. In contrast, in some countries, such as Denmark and the Netherlands, out-of-pocket expenditures for both hospital and long-term care are small. Finally, in other countries, such as Japan, the norm is a co-insurance rate for both hospital and long-term care. We will study how medical spending risks are mitigated through these different systems, and how the redistribution provided by the financing of these systems compares with one another. Ours will be the most systematic analysis to date of (1) the reduction in medical expense risk provided by Medicaid and Medicare by different income groups, (2) how the taxes needed to fund these programs are paid by different income groups, and (3) the first analysis for England and other countries and how they compare with the U.S.