We found a significantly inverse relationship between the proportion of families receiving an offer of EBPI and the medical cost index ([chi square] test, p < .
As shown in Figure 2A, families in the four quartiles of income distribution display different trends in receiving an EBPI offer.
The observed inverse relationship between the proportion of families receiving an offer of EBPI and the medical cost index was confirmed by the multivariate analysis.
We used the model to predict a family's probability of receiving an EBPI offer based on different values of the cost index.
With the cost index increased from 5 to 15 percent, the share of families with EBPI would decrease from 43 to 39 percent for the entire sample.
Our analysis provides evidence that rising medical care costs reduce the EBPI availability and enrollment and increase the financial risk for those families retaining EBPI-EYEM.
Our study finding of families' reduced likelihood of receiving an EBPI offer in the study period is consistent with the literature.
Our analysis reveals inverse relationships between the growth in health care costs and the decreases in EBPI availability and enrollment, two relationships based on intra-state variation in the cost index over time rather than inter-state variation in cross section.
For the higher threshold, we found that the effects were not statistically significant, suggesting that EBPI continues to protect families against severe financial loss above 20 percent of family income.
Our goal here is to develop evidence regarding the evolution of EBPI in a health care market with increasing cost pressures and to provide a more complete story regarding the consequences of rising health care costs for EBPI's availability and enrollment, and the financial protection offered by it.
This study relied on families' reports of EBPI availability, including private insurance offered either by private and or by government employers.
First, our finding of significantly negative impacts of cost growth on EBPI availability and enrollment implies that controlling health care costs may be essential to maintain the role of EBPI in our health care system.