{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T12:29:14Z","timestamp":1793449754392,"version":"4.5.0"},"reference-count":65,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec id=\"ab-ioi250084-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Cross-sectional studies indicate that out-of-pocket (OOP) health care costs strain household finances, but few studies have examined the risk of incurring burdensome health care spending longitudinally among individuals in the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250084-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess burdensome OOP health care costs (and care foregone due to cost) over a 4-year period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250084-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>In this cohort study, data were analyzed on respondents to the 4-year longitudinal Medical Expenditure Panel Surveys (MEPS), a nationally representative household survey of the US noninstitutionalized population conducted from 2018 to 2022. Analyses were performed from November 2024 to October 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250084-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Primary outcomes included 4 cost-related outcomes: cost burden, defined as individual annual OOP medical spending greater than 10% of family income (&amp;amp;gt;5% for low-income individuals); catastrophic cost burden (CCB) defined as OOP spending greater than 40% of postsubsistence income; foregone care due to cost; and family-level cost burden. Risk was assessed using time-to-event analyses, overall and among subgroups, eg, baseline chronic disease, hospitalization, and uninsurance, and death during the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250084-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 12\u202f645 MEPS respondents, 74.6% (95% CI, 73.4%-75.8%) were aged 18 years or older and 50.6% (95% CI, 49.7%-51.6%) were female individuals (weighted); among adults, 50.3% (95% CI, 48.6%-52.0%) had a chronic disease, 7.9% (95% CI, 7.2%-8.7%) were hospitalized, and 2.3% (95% CI, 2.0%-2.6%) died. During year 1, 6.5% of adults experienced cost burdens (and 3.5% CCB); 17.4% (and 9.9% CCB) experienced these outcomes (respectively) at least once over 4 years. Overall, 24.7% of US individuals lived in families experiencing cost burdens over 4 years, and 11.2% lived in families experiencing CCBs. Overall, 26.7% of adults experienced either foregone care due to cost or cost burden over 4 years. Lower income, having no insurance, hospitalizations, and chronic disease were each associated with higher cost burden. Overall, 53.2% of decedents experienced cost burdens in 1 to 4 years before death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250084-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This cohort study found that the US health care system imposes cost burdens on a larger share of the population than suggested by cross-sectional analyses, and most individuals in the US will experience such burdens during their lifetimes. Policies that reduce OOP costs might improve the well-being of individuals in the US.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.6948","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T16:31:06Z","timestamp":1766421066000},"page":"203","source":"Crossref","is-referenced-by-count":4,"title":["Risk of Burdensome Health Care Spending Over Time in the US"],"prefix":"10.1001","volume":"186","author":[{"given":"Adam","family":"Gaffney","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"McCormick","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel L.","family":"Dickman","sequence":"additional","affiliation":[{"name":"Planned Parenthood of Montana, Billings"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bor","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenore","family":"Azaroff","sequence":"additional","affiliation":[{"name":"Edward M. 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