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Meeting basic consumption needs: a joint examination of food and medical care.

Over one-in-ten U.S. households are food insecure in·se·cure
1. Lacking emotional stability; not well-adjusted.

2. Lacking self-confidence; plagued by anxiety.

. That is, these households include members who do not always have access to enough food for active, healthy living because their household lacks money or other resources for food. Children (18.2%) are far more likely than adults (10.8%) to be in households suffering from food insecurity Insecurity
Inseparability (See FRIENDSHIP.)

Insolence (See ARROGANCE.)


introspective, vacillating Prince of Denmark. [Br. Lit.: Hamlet]


cartoon character who is lost without his security blanket.
 (Nord, Andrews & Carlson, 2005). At the same time, approximately 46 million Americans, or 16% of the population, are without health insurance (DeNavas-Walt, Proctor A person appointed to manage the affairs of another or to represent another in a judgment.

In English Law, the name formerly given to practitioners in ecclesiastical and admiralty 
 & Lee, 2006). Research suggests that spells without insurance are usually relatively short in duration, but can be relatively frequent (Nelson, 2003). Children are most likely to experience repeated spells without health insurance, whereas adults age 55-64 experience the most frequent insurance coverage transitions. In addition, health care costs continue to increase both in nominal amount and as a share of household expenditures (U.S. Bureau of Labor Statistics Bureau of Labor Statistics (BLS)

A research agency of the U.S. Department of Labor; it compiles statistics on hours of work, average hourly earnings, employment and unemployment, consumer prices and many other variables.
, 2007). One of the largest components of out of pocket medical expenditures, prescription drugs prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, , is driving much of the increase in out of pocket expenditures (Kaiser Family Foundation The Henry J. Kaiser Family Foundation (KFF), or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. , 2006; U.S. Bureau of Labor Statistics, 2007). Despite an extensive network of private and public food assistance programs and public health insurance options, these statistics demonstrate that it is difficult for millions of families to meet these basic needs. There is some evidence that family resource allocation resource allocation Managed care The constellation of activities and decisions which form the basis for prioritizing health care needs  decisions involve tradeoffs between basic needs (Long 2003; Sharpe, Fan & Hong, 2001), but there is little research that moves beyond cross-sectional estimates to examine family-level economic outcomes associated with the acquisition of food and medical care over time.

Data and Analyses

This study of the relationship between health insurance, medical expenditures and food insecurity examined panel data from the 2001 Survey of Income and Program Participation The Survey of Income and Program Participation (SIPP) is a statistical survey conducted by the Demographic Statistical Methods Division of the United States Census Bureau. The main objective of the SIPP is to provide accurate and comprehensive information about the income of  (SIPP See SIP.

SIPP - Single Inline Pin Package
). The SIPP is a nationally representative survey of the non-institutionalized United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  population conducted by the U.S. Census Bureau Noun 1. Census Bureau - the bureau of the Commerce Department responsible for taking the census; provides demographic information and analyses about the population of the United States
Bureau of the Census
. The three-year 2001 panel collects a "core" set of questions that are collected from respondents every four months. The SIPP also consists of "topical" modules for questions that are not asked each wave. The timing and frequency of the topical modules varies, as does the duration of the reference period to which the questions refer. The data used here were collected from January, 2003 to December, 2003 (waves 7, 8, and 9) and, depending on the rotation group In mechanics and geometry, the rotation group is the group of all rotations about the origin of 3-dimensional Euclidean space R3 under the operation of composition.  of the respondent, refer to a continuous 12 months that began as early as October 2002 and ended as late as December, 2003. It was from this 12-month period that health insurance status, employment, sociodemographic information, and family composition data were drawn. The analytic sample included 49,989 people age 0 to 87 who were members of 16,236 families in 2003. When weighted, this sample represented 170.3 million people who were members of 70.8 million families.

The multivariate The use of multiple variables in a forecasting model.  analyses focused on the relationship between food insecurity and medical out of pocket expenditures while explicitly controlling for the potential endogeneity of the two variables. Specifically, a two stage probit In probability theory and statistics, the probit function is the inverse cumulative distribution function (CDF), or quantile function associated with the standard normal distribution.  least squares estimation (2SPLS) that simultaneously fit the probit and least squares equations was used. This approach allowed us to account for the joint decision making made by households about food and medical expenditures. A 2SPLS estimation, rather than single-equation estimation methods, allowed food insecurity status to be included among the explanatory variables in the medical out of pocket expenditure equation, and medical out of pocket expenditures to help explain food insecurity.

Results and Discussion

The results from this nationally-representative sample of families found no evidence that food and medical expenditures crowd out one another. That is, when considering the economic circumstances of families, there was little evidence that food and medical expenditures were an either/or decision for families. Rather, as families' medical out of pocket expenditures decreased, they were more likely to experience food insecurity. Similarly, as medical out of pocket expenditures increased, families' risk of food insecurity lessened less·en  
v. less·ened, less·en·ing, less·ens
1. To make less; reduce.

2. Archaic To make little of; belittle.

To become less; decrease.

A secondary research question addressed how varying health insurance coverage across family members and over time (e.g., everyone was continuously-insured over the study period, at least one member was uninsured at some point in time) was associated with a medical out of pocket expenditures. The results indicated that families with a higher percentage of family members covered by health insurance also had higher medical out of pocket expenditures. Similarly, families with a lower percentage of family members covered by health insurance had lower medical out of pocket expenditures.

A final research question addressed how varying health insurance coverage across family members and over time (e.g., everyone was continuously-insured over the study period, at least one member was uninsured at some point in time) was associated with families' food insecurity status. The results indicated that the likelihood of all family members being uninsured for all 12 months was more than double for food insecure families (3.9%) compared to food secure families (1.9%). Similarly, the percentage of food insecure families with at least one family member uninsured at some point during the study period was more than double that of food secure families (58.7% versus 28.2%).

Several strengths of this research are worth noting. First, the use of families as the unit of analysis recognizes that food allocation, insurance procurement The fancy word for "purchasing." The procurement department within an organization manages all the major purchases. , and medical expenditure decisions do not typically take place at the individual level. Families generally pool resources and allocate these resources to maximize the wellbeing of its members. Second, the simultaneous estimation of food insecurity and medical care expenditures provides greater confidence about the nature of the relationship than single-stage estimations. Finally, our consideration of the relationship between family-level food insecurity and medical care expenditures, over a one-year period, using nationally-representative data, is an advancement over individual-level, cross sectional sec·tion·al  
1. Of, relating to, or characteristic of a particular district.

2. Composed of or divided into component sections.


The results of this research are contrary to findings from smaller studies that suggest that individuals and families make choices between food and medical care or services (Biros, Hoffman, & Resch, 2005; Kersey kersey

coarse, narrow cloth used for leg bandages in horses.
 et al., 1999). Because the literature is not clear on the relationship between expenditures on food and medical care, future research will investigate the unique economic situations of those who have low incomes. Similarly, although seniors residing in families are included in this research, seniors who live alone and/or not with a family are excluded. An extension of this work will include separate analyses of senior families and senior households to investigate the unique challenges faced by the elderly, especially the elderly who are in poverty or who have low incomes.

The results of this research suggest that programs that seek to help families to obtain food or health care actually may be generating benefits beyond meeting that specific need if one considers cross-program gains. When resources available for one basic need, such as food, are increased, resources for other basic needs are more readily available. As policymakers and program administrators continue to devise ways to help families meet their needs, they should consider the overlapping benefits of food assistance and health insurance programs.


Biros, M., Hoffman, P., & Resch, K. (2005). The prevalence and perceived health consequences of hunger in emergency department patient populations. Academic Emergency Medicine, 12(4), 310-317.

DeNavas-Walt, C., Proctor, B., & Lee, C. (2006). Income, poverty, and health insurance coverage in the United States: 2005. Washington, DC: U.S. Department of Commerce, U.S. Census Bureau.

Kaiser Family Foundation. Distribution of out-of-pocket spending for health care services. Retrieved April 4, 2007 from

Kersey, M., Beran, M., McGovern, P., Biros, M., & Lurie, N. (1999). The prevalence and effects of hunger in an emergency department patient population. Academic Emergency Medicine, 6(11), 1109-1114.

Long, S. (2003). Hardship among the uninsured: Choosing among food, housing, and health insurance. Washington, DC: The Urban Institute.

Nelson, L. (2003). How many people lack health insurance and for how long? Washington, DC: Congressional Budget Office The Congressional Budget Office (CBO) is responsible for economic forecasting and fiscal policy analysis, scorekeeeping, cost projections, and an Annual Report on the Federal Budget. The office also underdakes special budget-related studies at the request of Congress. .

Nord, M., Andrews, M., & Carlson, S. (2005). Household food security in the United States, 2004. Washington, DC: United States Department of Agriculture United States Department of Agriculture (USDA), established in 1862, USDA is responsible for the safety of meat, poultry, and egg products. It conducts ongoing research in areas from human nutrition to new crop technologies and also helps ensure open
, Economic Research Service.

Sharpe, D., Fan, J. & Hong, G. (2001). Household out-of-pocket health care expenditure trends: 1980-95. International Journal of Consumer Studies, 25(2), 114-122.

U.S. Bureau of Labor Statistics. (2007). Consumer expenditures in 2005. Washington, DC: U.S. Department of Labor.

Robert B. Nielsen, University of Georgia Organization
The President of the University of Georgia (as of 2007, Michael F. Adams) is the head administrator and is appointed and overseen by the Georgia Board of Regents.

Steve Garasky, Iowa State University Academics
ISU is best known for its degree programs in science, engineering, and agriculture. ISU is also home of the world's first electronic digital computing device, the Atanasoff–Berry Computer.


(1) Assistant Professor, Housing and Consumer Economics, University of Georgia, Athens, GA.

(2) Associate Professor, Human Development and Family Studies, Iowa State University, Ames, IA.
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Author:Nielsen, Robert B.; Garasky, Steve
Publication:Consumer Interests Annual
Geographic Code:1USA
Date:Jan 1, 2007
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