UsingQuantile Regression to Examine Health Care Expenditures during the Great Recession

Objective. To examine the association between the Great Recession of 2007–2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Data Sources/Study Setting. Secondary data analyses of the Medical Expenditure Panel Survey (2005–2006 and 2008–2009). Study Design. Quantile multivariate regressions are employed to measure the differ-ent associations between the economic recession of 2007–2009 and health care spend-ing. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportion-ately lower health spending during the economic recession. Principal Findings. TheGreat Recession was significantly associated with reductions in health care expenditures at the 10th–50th percentiles of the distribution, but not at the 75th–90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also posi-tively associated with spending on emergency department visits. Conclusion. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. Key Words. Health care expenditures, quantile regression, economic recession, racial and ethnic disparities The longest of any recession since World War II officially began in Decembe