TUESDAY, Dec. 12 (HealthDay) -- More Americans are forced to spend more of their family income on health care, and more middle-class Americans are joining the ranks of those spending a disproportionate share of their budget on such expenses, a new study finds.

An estimated 50 million Americans under the age of 65 live in families that spend more than 10 percent of their family income on health care, an increase of more than 10 million people over the past decade.

"We know health-care costs are rising, we know premiums are rising to reflect greater health-care costs, but we didn't know how they're actually affecting family's budgets," said study co-author Jessica Banthin.

"There's been a large increase in the number of people living with these kinds of financial burdens," added Banthin, director of the division of modeling and simulation at the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Carol Pryor, a senior policy analyst at The Access Project in Boston, which works with local communities to improve health and health-care access, said, "This reinforces findings that have been accumulating about the increasing amount of medical debt and the financial burden that goes along with it. We can be sure some expenses are turning into debt. This has access consequences as well as serious financial consequences, such as using up savings or not being able to pay for food or utilities."

Health-care costs have been outpacing the rest of the U.S. economy for years.

In 2004, national health expenditures took up 16 percent of the gross domestic product, up from 13.6 percent in 1997 and 9.1 percent in 1980. At the same time, individuals' out-of-pocket payments for health-care services rose from $162 billion in 1997 to $236 billion in 2004.

But it's been unclear how these changes have been affecting family budgets.

For the new study, published in the Dec. 13 issue of the Journal of the American Medical Association, the researchers looked at data from a nationally representative sample of Americans younger than 65.

In 2003, 48.8 million people -- 19.2 percent of the population -- were living in families spending more than 10 percent of their family income on health care, an increase of 11.7 million people since 1996. The findings included all out-of-pocket expenses, such as insurance premiums.

Of these, 18.7 million people -- 7.3 percent of the population -- were spending more than 20 percent of family income on health care.

In 2003, those at higher-than-average financial risk included low-income individuals and those with chronic medical conditions.

"It's not surprising, but people who need health care the most are some of the people with the highest burden," Banthin said.

The middle class is also being hit harder than in the past.

"About 23 percent of middle-income individuals are living in families that spend more than 10 percent of their budget on health care, and that's the same risk as people in low-income families. In 1996, that was not true -- middle-income individuals had a lower risk of facing these high burdens, and now they have very similar risk," Banthin said.

Pryor added, "The level of risk is creeping up the income scale. The problems are becoming an issue for more and more people."

The study authors concluded that an estimated 17.1 million people under the age of 65 were underinsured (meaning health-care burdens that exceeded 10 percent of tax-adjusted family income) in 2003. This included 9.3 million people with private employment-related insurance, 1.3 million people with private non-group policies, and 6.6 million persons with public coverage.

The findings also shed new light on the non-group health insurance market -- people who buy their insurance directly.

"This highlights the role of the non-group market and how expensive it is, people who buy insurance directly," Banthin said. "When you add their premiums and out-of-pocket together, more than half of the people who fall into that category are spending 10 percent or more of their family income on health care."

"This provides information to policy makers to show who exactly is bearing these higher costs and how they're impacting people's family budgets," she added.

More information

The Kaiser Family Foundation has more on uninsured Americans.

SOURCES: Jessica S. Banthin, Ph.D., director, division of modeling and simulation, Agency for Healthcare Research and Quality, Rockville, Md.; Carol Pryor, senior policy analyst, The Access Project, Boston; Dec. 13, 2006, Journal of the American Medical Association

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