View Research by Author - Kyle Caswell

Kyle J. Caswell, PhD, is an economist and research associate at The Urban Institute's Health Policy Center. His current research focuses on the affordability of medical care, the potential value of disability insurance, and inequalities in health outcomes. Before coming to The Urban Institute he worked as an economist at the U.S. Census Bureau, Health and Disability Statistics Branch. There he contributed to the medical out-of-pocket spending component of the Supplemental Poverty Measure. During his previous tenure at The Urban Institute Kyle worked with others to develop estimates of potential savings in medical spending attributable to prevention programs.

Publications

This study is the first to offer a detailed look at medical spending burden levels, defined as total family medical out-of-pocket spending as a proportion of income, for each state. It further investigates which states have greater shares of individuals with high burden levels and no Medicaid coverage, but would be Medicaid eligible under the 2014 rules of the Affordable Care Act should their state choose to participate in the expansion. This work suggests which states have the largest populations likely to benefit, in terms of lowering medical spending burden, from participating in the 2014 adult Medicaid expansions.

We estimate the financial burden of medical spending among the non-elderly using an alternative data source than previous studies. We investigate whether higher burden levels are largely due to higher medical spending, lower income, or some combination. Furthermore, we study individual characteristics correlated with burdens exceeding a given threshold. Although medical spending is higher for individuals facing higher burden levels, the effect of low income on high burden status dominates. Multivariate analysis shows that individuals covered by non-group insurance and the unhealthy have significantly higher risk of facing higher burden levels, while those with public insurance have much lower risk.

The authors present national and state-level estimates of effects on medical spending over time of reductions in the prevalence of conditions amenable to primary prevention. Reducing diabetes and hypertension prevalence by 5% nationally would save approximately $8.2 billion annually in the near term. The resulting reductions in comorbidities could bring medium-term savings to approximately $26.8 billion annually. Returns are greatest in absolute terms for private payors, but greatest in percentage terms for public payors. State savings vary with demographic makeup and prevailing morbidity. We conclude that well-designed interventions that achieve improvements in lifestyle-related risk factors could result in sufficient savings to substantially offset intervention costs.

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