combine the elderly and nonelderly into a single measure. All of the previous estimates with which she is familiar always look at them separately. In her previous work, different thresholds were applied for the nonelderly and the elderly populations; for the nonelderly, for example, cutoff points of 10 and 20 percent of income spent on medical care were applied (Banthin and Bernard, 2006). She has also done work in which cutoff points of 5 percent were applied to low-income people and 10 percent for others (Banthin, Cunningham, and Bernard, 2008). In a paper that looked at annual burdens for the elderly, she and a colleague actually applied different cutoff points of 20 and 40 percent to the nonelderly and the elderly, respectively because the elderly spend a lot more on health care (Selden and Banthin, 2003).

Why differentiate between the elderly and the nonelderly? Younger families clearly have higher incomes, because generally they are working. They have higher expenses, including work-related expenses and child care, than the Supplemental Poverty Measure recognizes. Also, they are expected to be saving for their future retirement. And of course generally they are in better health, so their medical care needs are lower.

For older families, if they are retired their incomes are lower, they have fewer competing expenses along the lines of work-related and childrearing expenses, and their health needs are generally higher and they are in generally worse health. At the point at which they retire, they have been building up their assets, and now they are expected to draw down their assets in some way or other. That is why the elderly and the nonelderly have always been separated.

Two questions need to be answered. First, how is a reasonable cutoff point or threshold defined for both the elderly and the nonelderly populations that would indicate high medical care risk or high burden? Second, how does one incorporate the accumulated savings of retired families into the measure of resources available for financing health care expenditures?

Banthin addressed the self-employed briefly. No one had really looked at them separately, or some people have but not in the context of financial burden, she said. The question is whether the self-employed have such high levels of assets (including business assets) that they warrant a separate approach in measuring health care burden.

Data and Methods

The Medical Expenditure Panel Survey (MEPS) is used for this analysis, taking advantage of the asset data that it collects. MEPS is designed with 2-year panels that overlap one another, and Banthin and Bernard pooled three panels—panels 10-12, 2005-2008.

They used three panels as the sample size, that is, about 1.5 times an annual sample from MEPS, which most people use. MEPS is a unique



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