Virginia Anesthesia Services LLC Trends in Individual Medical Debt - Virginia Anesthesia Services LLC

Trends in Individual Medical Debt

The cost of medical care is an important public health variable. Not only can medical debt lead to asset depletion, bankruptcy and emotional distress, but it can also cause patients to delay obtaining care because they can’t afford it3. Unfortunately, statistics on medical debt have shown trends of increasingly prevalent hardship.

A 2019 study found that in that past year, 137.1 million Americans reported medical financial hardship, and of that group, 25% reported two or more domains of financial hardship3. The intensity of this hardship was felt more by younger people, despite the fact that older patients dealt with more chronic conditions and typically were part of lower income households3. This can likely be attributed to Medicare, but even so, at least a third of the patients older than sixty-five experienced medical financial hardship in at least one domain3. These trends in medical debt prevalence will likely get worse, as chronic multiple morbidity prevalence and cost of healthcare increase in the future3. This study also looked at financial hardship disparity across insurance types and found significant differences between the groups3. The uninsured group, ages 18-64 experienced more hardship than any other by far, with about 75% of the group reporting hardship in at least one domain3. By contrast, only 25% of patients in the same age group with private insurance reported medical financial hardship3. But even here there is nuance: people with private insurance can often have high deductibles and greater cost-sharing, which can also cause financial hardship in and of itself3. Other factors that contribute to or are associated with medical debt are high out-of-pocket costs for prescription medications and lower levels of education3.

As referenced above, patients with chronic conditions are deeply impacted by rising healthcare costs and are especially affected by medical debt2. Households with any chronic morbidities are at higher risks of having out-of-pocket costs and medical debt than households without2. And while it’s true that these patients are directly at higher risk of medical debt because their health care expenses are higher and more frequent, they are also at risk of being in debt due to loss of employment2. Chronic health conditions can lead to “productivity shock,” where patients experiencing such health issues aren’t able to work at all or at the same level of productivity as they were before2.

Furthermore, there are important social factors associated with medical debt; a study done in 2020 looked at the effects of housing insecurity on the presence of medical debt, which was something that had not ever been previously studied1. People experiencing homelessness are at risk for many kinds of debt and financial hardship, however, medical debt exists independently, even after controlling for other social factors1. And interestingly, this relationship goes two ways: homelessness is a predictor of medical debt, and medical debt is a predictor for length of housing insecurity1. This study found that even a small amount of medical debt can prolong how long a person experiences homelessness and can increase chance of home foreclosure, and that having health insurance did not protect against this1.

These trends are important to consider in discussions of healthcare equality and reducing disparities. Patient-level interventions such as health literacy education seminars, free healthcare screenings, and connections to community programs, as well as Medicare expansion plans in certain states have improved these trends, but more intervention on local and federal levels is required to reduce medical debt as a public health concern3.

References

  1. Bielenberg JE, Futrell M, Stover B and Hagopian A. Presence of Any Medical Debt Associated with Two Additional Years of Homelessness in a Seattle Sample. Journal of Health Care Organization, Provision and Financing, 2020; 57: 1-10. doi: 10.1177/0046958020923535 
  2. Richard P, Walker R and Alexandre P. The burden of out of pocket medical costs and medical debt faced by households with chronic health conditions in the United States. PLOS ONE, 2018; 13(6): e0199598. doi: 10.1371/journal.pone.0199598
  3. Yabroff KR, Zhao J, Han X, and Zheng Z. Prevalence and Correlates of Medical Financial Hardship in the USA. Journal of General Internal Medicine, 2019; 34: 1494-1502. doi: 10.1007/s11606-019-05002-w