Table 1 Select examples of studies examining the association between the recession and health care utilization

Holahan J

To quantify changes in health insurance coverage seen during the recent recession

Data from the Census Bureau’s Current Population Survey (CPS) used to describe trends in coverage

· From 2007–09, number of uninsured nonelderly Americans increased by 5.6 million, from 45 to 50 million

· Midwest experienced much larger drop in employer-sponsored insurance and smaller increases in public insurance than Northeast

Lusardi A et al.

To study the association between shocks to resources and changes in routine medical care Usage

Data from nationally representative survey of individuals 18–65 years of age in the US, UK, France, Germany, and Canada during 2009 using multivariate regression models

· Individuals whose wealth fell by 30-50% were more likely to have reduced routine medical care use relative to individuals who experienced a smaller or no loss of wealth

· Stronger effects were found among the unemployed and in the U.S. than other countries; more than a quarter of Americans reported reducing their routine medical care use during the current economic recession

Fronstin P

To examine the extent of health insurance coverage prior to and during the recession

Data from Survey of Income and Program Participation used to describe monthly changes in coverage prior to and during the recession, with emphasis on period between Sept 2007 and April 2009

· Among workers with employee-only coverage, average deductible in large firms increased from $254 in 2005 to $478 in 2009, an 88% increase, while in small firms it increased from $469 to $1,040, a 122% increase.

· Younger workers were more likely to lose insurance coverage than older workers. Workers ages 45–54 experienced the largest increase in the percentage uninsured, increasing from 8.6% to 13.1% (or 52.3 percent) while older workers experienced the smallest increase, 8.2%.

Hartman et al.

To examine the impact of the recession on trends in U.S. health spending

Data from annual cross-sectional analysis of U.S. health spending used to describe trends

· In 2008, U.S. health care spending growth slowed to 4.4%, the slowest rate of growth over the previous 48 years

· Deceleration was broadly based for nearly all payers and health care goods and services, as growth in both price and non-price factors slowed

Truffer et al.

To examine the impact of the recession on trends in U.S. health spending

Data from annual cross-sectional analysis of U.S. health spending used to generate projections with actuarial and econometric modeling

· Slow down in rate of private health spending growth from 2009–2010 due to reduced private health insurance enrollment, which is a result of a continuing high rate of unemployment and the expiration of subsidies for coverage provided through COBRA