Out-Of-Pocket Spending: The Authors Respond

We thank Laura Trueman for reminding readers and us that estimatesin our paper (Web Exclusive, 2 June 2009) pertain to singles,not families. We restricted the analysis in this way becauseresources were limited and the model we had developed at thetime applied to single adults only. Family coverage also raisescomplexity in that families vary in size and a particular family’sout-of-pocket spending will be driven in part by the numberof family members covered. Our focus on single adults demonstratesthe wide variation in out-of-pocket spending that exists evenat the individual level.

From our other unpublished work, we can report that high usersoften are spread across families rather than concentrated withina few families. That can temper the costs at the family level,but it is little comfort to those families who experience highcosts for several family members in the same year. Additionally,members’ contributions toward health insurance premiumsare much higher for family coverage. The Kaiser Family Foundation/HealthResearch and Educational Trust 2008 Employer Health BenefitSurvey reports that the average employee annual contributionfor single coverage is $721, compared to $3,354 for family coverage.¹

Jon Gabel
NORC at the University of Chicago, Bethesda, Maryland

NOTE

Claxton G, Gabel J, DiJulio B, Whitmore H, Pickreign J, Finder B, et al. Premiums moderately higher, while enrollment in consumer-directed plans grows in small firms. Health Aff (Millwood). 2008;27(6):w492–502.[Abstract/Free Full Text]

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Out-Of-Pocket Spending: The Authors Respond