Measuring financial protection in health in the United States

Hugh R. Waters, Gerard F. Anderson, Jim Mays

Research output: Contribution to journalArticlepeer-review

87 Scopus citations


One rationale for health insurance coverage is to provide financial protection against catastrophic health expenditures. This article defines a lack of financial protection as household spending on health care when: (1) out-of-pocket (OOP) health expenditures exceed 10% of family income; (2) out-of-pocket expenditures exceed an absolute level of US$ 2000 per family member on an annual basis; and (3) combined out-of-pocket and prepaid health expenditures exceed 40% of family income. The article explores how the likelihood of households in the United States surpassing these thresholds varies by income level, extent of insurance coverage, and the number of chronic conditions. The results show clearly that there is a lack of financial protection for health services for a wide segment of the US population - particularly so for poor families and those with multiple chronic conditions. The results are placed in an international context. Similar studies in other countries would allow for more in-depth comparisons of financial protection than are currently possible.

Original languageEnglish (US)
Pages (from-to)339-349
Number of pages11
JournalHealth policy
Issue number3
StatePublished - Sep 2004


  • Catastrophic spending
  • Financial protection
  • Financial shocks
  • Health expenditures

ASJC Scopus subject areas

  • Health Policy


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