According to Commonwealth Fund-supported research by Peter Cunningham and colleagues, out-of-pocket health care expenses as a share of income are on the rise among American families, with much of the increase accounted for by people with individual insurance and lower incomes. This trend is especially alarming, as evidence shows that people with high burdens are more likely to avoid needed health care and medications. This project will produce new estimates of out-of-pocket expenditures, which will be incorporated into the Commission on a High Performance Health System's revised National Scorecard, slated for release in 2008. The project will also provide new data on the scope and duration of medical bill problems from 2003–2007, the role of health care providers in assisting patients with their medical costs, and the extent and consequences of high medical cost burdens for people with chronic health conditions.