The Effects of Household Medical Expenditures on Income Inequality in the United States

Am J Public Health. 2018 Mar;108(3):351-354. doi: 10.2105/AJPH.2017.304213. Epub 2018 Jan 18.


Objectives: To assess the effect of households' outlays for medical expenditures on income inequality and changes since the implementation of the Affordable Care Act (ACA).

Methods: We analyzed data from the US Current Population Surveys for calendar years 2010 through 2014. We calculated the Gini index of income inequality before and after subtracting households' medical outlays (including insurance premiums and out-of-pocket costs) from income, the financial burden of medical outlays for each income decile, and the number of individuals pushed below poverty by medical outlays.

Results: In 2014, the Gini index was 47.84, which rose to 49.21 after medical outlays were subtracted, indicating that medical outlays effectively redistributed about 1.37% of total income from poorer to richer individuals, a slightly smaller redistribution compared with the years before the ACA. Medical outlays reduced the median income of the poorest decile by 47.6% versus 2.7% for the wealthiest decile and pushed 7.013 million individuals into poverty.

Conclusions: The way we finance medical care exacerbates income inequality and impoverishes millions of Americans. This regressive financing pattern improved minimally in the wake of the ACA.

MeSH terms

  • Deductibles and Coinsurance
  • Health Expenditures / statistics & numerical data*
  • Income / statistics & numerical data*
  • Insurance, Health / economics*
  • Patient Protection and Affordable Care Act / economics*
  • Poverty
  • Surveys and Questionnaires
  • United States