Out-of-Pocket Costs and Health-Related Social Needs Among Households With Children.

Abstract

Rising health care costs could make it tougher for households with children to meet their health-related social needs (HRSNs), ie, accessing food, paying bills, and living in quality housing. To examine the association between out-of-pocket medical financial burdens among households with children and HRSNs. This retrospective cohort study used data from the US Census Bureau's Survey of Income and Program Participation 2014, 2018, 2020, 2021, and 2022 panels. Households with children who participate in the first 3 years of each 4-year panel were included. Analyses were performed between October 6, 2025, and February 27, 2026. Households spending either 5% or 10% or more of their income on out-of-pocket medical costs and experiences of out-of-pocket financial burdens. Household reports of food insecurity, difficulty paying bills (mortgage or rent and utilities), and living in poor-quality housing (eg, chronic plumbing problems) in the third year of each panel. Inverse probability of treatment weights were used to account for socioeconomic and health-related characteristics that could confound the association between out-of-pocket burdens and later HRSNs. Logistic regressions were used to estimate the association between out-of-pocket burden in the second year of each panel and HRSNs in the third year. The analytic sample included 6940 households (number of householders [weighted percentage]: 3222 aged 18-44 years [49.0%], 3891 female [54.5%]). Exposure to both 5% out-of-pocket burdens (odds ratio, 1.80; 95% CI, 1.31-2.48) and 10% out-of-pocket burdens (odds ratio, 1.90; 95% CI, 1.32-2.75) in year 2 were associated with a greater likelihood of food insecurity in year 3. No associations were found between out-of-pocket spending in year 2 and difficulty paying bills or living in poor-quality housing in year 3. The findings of this cohort study of US households with children suggest that high out-of-pocket medical costs may make it more difficult for households to afford HRSNs, potentially contributing to adverse health outcomes.