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Hubbard S. Education and Financial Knowledge in Health-Related Financial Decisions. Health Educ Behav 2024:10901981241227168. [PMID: 38258824 DOI: 10.1177/10901981241227168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The high cost of health care in the United States creates complex decisions where suboptimal choices may negatively affect an individual's physical and financial health. The challenge for patients is that the complex nature of health-related financial decisions requires specialized knowledge to avoid these suboptimal choices. While the benefits of improved health literacy are well documented, the connection between health care and household finances may mean that there is a role for education and financial knowledge in improving outcomes. This study uses data from the Financial Industry Regulatory Authority's Financial Capability Survey in a binomial logistic regression to examine the role of education and financial knowledge in health-related financial decisions. The results show that both higher levels of education and financial knowledge are related to a higher likelihood of obtaining health insurance coverage and a lower likelihood of having medical debt and engaging in cost avoidance. Income disparities remain, however, especially for those in the middle-income brackets. These results raise the possibility that increases in general education and financial knowledge may improve health outcomes, but those facing the most complex health care decisions may need more specialized knowledge. This implies that given the connection between health care and personal finances, increasing objective and subjective knowledge may lead to better outcomes for patients' financial and physical health.
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Affiliation(s)
- Sean Hubbard
- University of North Texas at Dallas, Dallas, TX, USA
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Cahn J, Sundaram A, Balachandar R, Berg A, Birnbaum A, Hastings S, Makansi M, Romano E, Majidi A, McCormick D, Gaffney A. The Association of Childbirth with Medical Debt in the USA, 2019-2020. J Gen Intern Med 2023; 38:2340-2346. [PMID: 37199904 PMCID: PMC10192781 DOI: 10.1007/s11606-023-08214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Medical debt affects one in five adults in the USA and may disproportionately burden postpartum women due to pregnancy-related medical costs. OBJECTIVE To evaluate the association between childbirth and medical debt, and the correlates of medical debt among postpartum women, in the USA. DESIGN Cross-sectional. PARTICIPANTS We analyzed female "sample adults" 18-49 years old in the 2019-2020 National Health Interview Survey, a nationally representative household survey. MAIN MEASURES Our primary exposure was whether the subject gave birth in the past year. We had two family-level debt outcomes: problems paying medical bills and inability to pay medical bills. We examined the association between live birth and medical debt outcomes, unadjusted and adjusted for potential confounders in multivariable logistic regressions. Among postpartum women, we also examined the association between medical debt with maternal asthma, hypertension, and gestational diabetes and several sociodemographic factors. KEY RESULTS Our sample included n = 12,163 women, n = 645 with a live birth in the past year. Postpartum women were younger, more likely to have Medicaid, and lived in larger families than those not postpartum. 19.8% of postpartum women faced difficulty with medical bills versus 15.1% who were not; in multivariable regression, postpartum women had 48% higher adjusted odds of medical debt problems (95% CI 1.13, 1.92). Results were similar when examining inability to pay medical bills, and similar differences were seen for privately insured women. Among postpartum women, those with lower incomes and with asthma or gestational diabetes, but not hypertension, had significantly higher adjusted odds of medical debt problems. CONCLUSIONS Postpartum women experience higher levels of medical debt than other women; poorer women and those with common chronic diseases may have an even higher burden. Policies to expand and improve health coverage for this population are needed to improve maternal health and the welfare of young families.
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Affiliation(s)
- Jordan Cahn
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ayesha Sundaram
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Roopa Balachandar
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Alexandra Berg
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Aaron Birnbaum
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Stephanie Hastings
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Matthew Makansi
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Emily Romano
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ariel Majidi
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
| | - Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA
- Harvard Medical School, Boston, MA USA
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Eliason EL, MacDougall H, Peterson L. Understanding the Aggressive Practices of Nonprofit Hospitals in Pursuit of Patient Debt. Health Soc Work 2022; 47:36-44. [PMID: 34893829 DOI: 10.1093/hsw/hlab034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/04/2021] [Indexed: 06/14/2023]
Abstract
Nonprofit hospitals have attracted scrutiny for aggressive collection activities against patients, which persist despite the Patient Protection and Affordable Care Act's attempt to limit particularly egregious practices, called "extraordinary collection actions" (ECAs). This study examines the prevalence of ECAs and characteristics of nonprofit hospitals that reported this behavior as of 2016. Using Community Benefit Insight data, characteristics of hospitals that reported ECAs are compared with hospitals that did not report these practices. ECAs include reporting patient debt to credit agencies, filing lawsuits, placing liens on residences, and issuing civil arrest. Predictors of ECAs among nonprofit hospitals are identified using logistic regression analysis. The prevalence of ECAs is examined for the 2010-2016 time period, and nonprofit hospitals that reported ECAs are mapped to show the geographic distribution. Hospitals reporting ECAs significantly differed in total revenue, system membership, bed size, urban location, financial assistance policy use, and use of poverty guidelines for discounted care. In full logistic regression models, lower total hospital revenue was a significant predictor of ECAs. As social workers, it is vital to understand the landscape of nonprofit hospital collection actions to advocate for policy that protects patients from predatory practices while holding nonprofit hospitals accountable.
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Richard P, Patel N, Lu YC, Walker R, Younis M. The Financial Burden of Cancer on Families in the United States. Int J Environ Res Public Health 2021; 18:3790. [PMID: 33916454 DOI: 10.3390/ijerph18073790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022]
Abstract
This study examined the relationship between a diagnosis of cancer and the likelihood of having any out-of-pocket costs (OOPC) and medical debt, and the amounts of OOPC and medical debt, at the household level. We used the 2013 Panel Study of Income Dynamics, a continuous, representative panel survey that collects demographic, economic, and social data in the United States. The analytic sample included head of households and their spouse (if married), 18–64 years old. Two-part models were used. The first part consisted of logistic regression models and the second part consisted of generalized linear models with logarithmic link and a gamma distribution. Logistic regression results showed odds of 2.13 (CI: 1.27, 3.57, p < 0.01) for any OOPC and odds of 1.55 (CI: 0.93, 2.58, p < 0.1) for any medical debt for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to those that did not report a diagnosis of cancer. Likewise, results from the second part of the model for households with a positive amount of OOPC showed an exponentiated coefficient of 1.73 (CI: 1.33, 2.25, p < 0.01) for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to households without a diagnosis of cancer. This study shows that a diagnosis of cancer places a financial burden on families, particularly with all types of debt, in the United States even after controlling for differences between households with a diagnosis of cancer and those without a diagnosis of cancer.
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Jiang J, Chen S, Xin Y, Li L, Xiang L. Economic crisis of rural patients insured with critical illness insurance: Do working-age patients have higher financial burden? Health Soc Care Community 2021; 29:496-505. [PMID: 32720413 DOI: 10.1111/hsc.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
Working-age patients are generally found to have higher healthcare expenditure than elder. China implemented critical illness insurance (CII) in 2012 to decrease the medical expenditure of patients. The aim of this study was to determine if the economic burden of rural working-age patients with CII was more serious than other age groups. A questionnaire survey was undertaken in two counties of central and western China in 2017. Comprehensive financial measurement was used, including direct costs, indirect costs and medical debt rate. All data collected were used for descriptive statistics and multivariate variance analysis. Linear regression with random effect analysis upon area was used to evaluate the differences in ages. A total of 834 rural patients were surveyed in this study. Patients aged 18-44 years had the highest lodging and food payments (3,838 Chinese Yuan [CNY]), work loss (15,350 CNY) and medical debt rate (83.24%). Patients who were of working age, sought health services out of counties, had longer length of stay, and were diagnosed with chronic illness had higher healthcare expenditure. Rural working-age patients with CII had higher direct and indirect costs, which were attributed to medical debt. The increased service capability of hospitals in counties and improved medical financial assistance may also be issues of concern.
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Affiliation(s)
- Junnan Jiang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, Hubei, China
| | - Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Yanjiao Xin
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lu Li
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Acharya Y, Hillemeier MM, Sznajder KK, Kjerulff KH. Out-of-Pocket Medical Bills from First Childbirth and Subsequent Childbearing. Womens Health Issues 2021; 31:17-23. [PMID: 32896469 PMCID: PMC7770019 DOI: 10.1016/j.whi.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Many families in the United States struggle to pay medical debt. This study aims to investigate the association between having out-of-pocket medical bills from first childbirth sent to debt collection agencies and subsequent childbearing. METHODS As part of a large-scale birth cohort study (N = 2,169), women in Pennsylvania who delivered their first child in 2009 through 2011 were asked if any of the out-of-pocket medical expenditures resulting from the delivery were sent to debt collection agencies. Logistic regression models were used to assess the association between childbirth medical bills going to debt collections in the first year after delivery and subsequent childbearing over the following 2 years, controlling for relevant confounders, including maternal age, education, race/ethnicity, marital status, poverty level, insurance coverage, pregnancy intendedness, difficulty paying for basic needs, plans to have another child, pregnancy complications, and childbirth maternal and neonatal complications. RESULTS Women received out-of-pocket medical bills for as much as $32,000. Overall, 8.3% reported having medical bills from the childbirth sent to debt collections. These women were substantially less likely to have a subsequent child during the follow-up period (22.4%) compared with their counterparts, whose medical bills did not go to collections (44.4%; adjusted odds ratio, 0.60; 95% confidence interval, 0.39-0.93). CONCLUSIONS When out-of-pocket medical bills from first childbirth are more than American families can afford to pay, they may postpone having a second child. This finding may be particularly true when childbirth medical bills are sent to debt collection agencies.
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Affiliation(s)
- Yubraj Acharya
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania.
| | - Marianne M Hillemeier
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania
| | - Kristin K Sznajder
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, Pennsylvania
| | - Kristen H Kjerulff
- Departments of Public Health Sciences and Obstetrics and Gynecology, The Pennsylvania State University, Hershey, Pennsylvania
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Abstract
Purpose: To examine indebtedness for medical care among racial and ethnic minorities and people with serious psychological distress (SPD) using a nationally representative sample in the United States. Methods: Using the 2014–2017 Medical Expenditure Panel Survey, we examine medical debt among individuals with SPD. We develop a logistic regression model to estimate the odds of medical debt by SPD status. We stratify the odds of medical debt for those with SPD by insurance type. Results: The results indicate that after controlling for predisposing, enabling, and physical needs factors, those experiencing SPD have double the odds of having medical debt compared with those without SPD. Non-Hispanic blacks had higher odds of medical debt compared with non-Hispanic whites. We find that individuals with SPD covered under private health insurance have double the odds of having medical debts; and those who are uninsured have triple the odds of having medical debt compared with their counterparts without SPD. Conclusion: The findings suggest that odds of medical debt are higher among people with SPD, even when insured. Additional health policy initiatives to address medical debt among those with SPD may be warranted.
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Affiliation(s)
- Priscilla J Novak
- Department of Health Policy and Management, School of Public Health, University of Maryland at College Park, College Park, Maryland, USA
| | - Mir M Ali
- Department of Health Policy and Management, School of Public Health, University of Maryland at College Park, College Park, Maryland, USA
| | - Maria X Sanmartin
- Department of Health Professions, Hofstra University, Hempstead, New York, USA
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Dean CA, Wiltshire J, Liu E, Amamoo MA, Garcia Colato E, Elder K. Confidence in Understanding Health Insurance and Challenges Paying Medical Bills Among Men in the United States. Am J Mens Health 2020; 14:1557988320943359. [PMID: 32693654 PMCID: PMC7376301 DOI: 10.1177/1557988320943359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen's model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015-2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants' difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97-.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56-.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills.
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Affiliation(s)
- Caress A. Dean
- Department of Public and Environmental
Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | | | - Echu Liu
- Department of Health Management and
Policy, Saint Louis University, Saint Louis, MO, USA
| | - M. Ahinee Amamoo
- School of Public Health, Samford
University, Birmingham, AL, USA
| | | | - Keith Elder
- School of Public Health, Samford
University, Birmingham, AL, USA
- Keith Elder, School of Public Health,
Samford University, 800 Lakeshore Drive, Birmingham, AL 35229, USA.
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Li J, Jiao C, Nicholas S, Wang J, Chen G, Chang J. Impact of Medical Debt on the Financial Welfare of Middle- and Low-Income Families across China. Int J Environ Res Public Health 2020; 17:ijerph17124597. [PMID: 32604840 PMCID: PMC7344870 DOI: 10.3390/ijerph17124597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/10/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low- and middle-income households. METHOD Data were obtained from the 2015 China Household Finance Survey, with medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence. RESULTS We found that 2.42% of middle-income families had medical debt, averaging US$6278.25, or 0.56 times average household yearly income and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times average household yearly income. The concentration index for low and middle-income families' medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poverty households deeper into poverty. While catastrophic health expenditure (CHE) was the single most important factor in medical debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt. CONCLUSIONS Using a narrow definition of medical debt, the incidence of medical debt in Chinese low- and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify China's basic medical insurance schemes to manage out-of-pocket, medical debt and CHE and to take account of pre-existing medical debt.
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Affiliation(s)
- Jiajing Li
- Center for Health Economics Experiment and Public Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan 250012, China; (J.L.); (C.J.)
| | - Chen Jiao
- Center for Health Economics Experiment and Public Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan 250012, China; (J.L.); (C.J.)
| | - Stephen Nicholas
- School of Economics and School of Management, Tianjin Normal University, No. 339 Binshui West Avenue, Tianjin 300387, China;
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, 2 Baiyun North Avenue, Guangzhou, Guangdong 510420, China
- Top Education Institute, 1 Central Avenue, Australian Technology Park, Eveleigh, Sydney, NSW 2015, Australia
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia
| | - Jian Wang
- Dong Fureng Institute of Economics and Social Development, Wuhan University, No. 54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China;
- Center for Health Economics and Management, Economics and Management School, Wuhan University, Luojia Hill, Wuhan 430072, China
| | - Gong Chen
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing 100871, China;
| | - Jinghua Chang
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing 100871, China;
- Correspondence:
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Bielenberg JE, Futrell M, Stover B, Hagopian A. Presence of Any Medical Debt Associated With Two Additional Years of Homelessness in a Seattle Sample. Inquiry 2020; 57:46958020923535. [PMID: 32513034 PMCID: PMC7285940 DOI: 10.1177/0046958020923535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although medical debt has been associated with housing instability, almost no research has connected homelessness to medical debt. We interviewed 60 individuals experiencing homelessness in Seattle, selected from those participating in self-governed encampments organized by a homeless advocacy organization. Most respondents reported having at least one kind of debt, with two-thirds reporting current medical debt. Almost half reported trouble paying medical bills for themselves or family members. Almost one-third believed medical debt was in part responsible for their current housing situation. More than half with medical debt incurred this debt while they were covered under insurance. People who had trouble paying medical bills experienced a more recent episode of homelessness 2 years longer than those who did not have such trouble, even after controlling for race, education, age, gender, and health status. People of color who had trouble paying medical bills reported almost 1 year more homelessness than whites.
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Affiliation(s)
| | - Marvin Futrell
- School of Public Health, University of Washington, Seattle, USA
| | - Bert Stover
- School of Public Health, University of Washington, Seattle, USA
| | - Amy Hagopian
- School of Public Health, University of Washington, Seattle, USA
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Yabroff KR, Zhao J, Han X, Zheng Z. Prevalence and Correlates of Medical Financial Hardship in the USA. J Gen Intern Med 2019; 34:1494-1502. [PMID: 31044413 PMCID: PMC6667570 DOI: 10.1007/s11606-019-05002-w] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/10/2018] [Accepted: 03/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND High patient out-of-pocket (OOP) spending for medical care is associated with medical debt, distress about household finances, and forgoing medical care because of cost in the USA. OBJECTIVE To examine the national prevalence of medical financial hardship domains: (1) material conditions from increased OOP expenses (e.g., medical debt), (2) psychological responses (e.g., distress), and (3) coping behaviors (e.g., forgoing care); and factors associated with financial hardship. DESIGN AND PARTICIPANTS We identified adults aged 18-64 years (N = 68,828) and ≥ 65 years (N = 24,614) from the 2015-2017 National Health Interview Survey. Multivariable analyses of nationally representative cross-sectional survey data were stratified by age group, 18-64 years and ≥ 65 years. MAIN MEASURES Prevalence of material, psychological, and behavioral hardship and hardship intensity. KEY RESULTS Approximately 137.1 million (95% CI 132.7-141.5) adults reported any medical financial hardship in the past year. Hardship is more common for material, psychological and behavioral domains in adults aged 18-64 years (28.9%, 46.9%, and 21.2%, respectively) than in adults aged ≥ 65 years (15.3%, 28.4%, and 12.7%, respectively; all p < .001). Lower educational attainment and more health conditions were strongly associated with hardship intensity in multivariable analyses in both age groups (p < .001). In the younger group, the uninsured were more likely to report multiple domains of hardship (52.8%), compared to those with some public (26.5%) or private insurance (23.2%) (p < .001). In the older group, individuals with Medicare only were more likely to report hardship in multiple domains (17.1%) compared to those with Medicare and public (12.1%) or Medicare and private coverage (10.1%) (p < .001). CONCLUSIONS Medical financial hardship is common in the USA, especially in adults aged 18-64 years and those without health insurance coverage. With trends towards higher patient cost-sharing and increasing health care costs, risks of hardship may increase in the future.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA.
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
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Abstract
Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and ratios of debt to income and debt to assets were positively associated with foregoing medical or dental care in the past 12 months, even after adjusting for the poorer socioeconomic and health characteristics of those foregoing care and for respondents' household incomes and net worth. These overall associations were driven largely by credit card and medical debt, while housing debt and automobile and student loans were not associated with foregoing care. These results suggest that debt is an understudied aspect of health stratification.
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Affiliation(s)
- Lucie Kalousova
- Department of Sociology, University of Michigan, Ann Arbor, MI 48103, USA.
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Abstract
BACKGROUND Health care providers are increasingly relying on collection agencies to recoup charges associated with medical care. Little is known about the prevalence of this practice in low-income communities and what effect it has on health-seeking behavior. METHODS Cross-sectional survey at 10 "safety net" provider sites in Baltimore, Md. Specific queries were made to underlying comorbidities, whether they had a current medical debt, actions taken against that debt, and any effect this has had on health-seeking behavior. RESULTS Overall, 274 adults were interviewed. The average age was 43.9 years, 77.3% were African American, 54.6% were male, 47.2% were homeless, and 34.4% had less than a 12th grade education. Of these, 46.2% reported they currently had a medical debt (average, 3,409 dollars) and 39.4% reported ever having been referred to a collection agency for a medical debt. Overall, 67.4% of individuals reported that either having a current medical debt or having been referred to a collection agency for a medical debt affected their seeking subsequent care: 24.5% no longer went to that site for care; 18.6% delayed seeking care when needed; and 10.4% reported only going to emergency departments now. In the multiple logistic regression model, having less than a 12th grade education (odds ration [OR], 2.5; 95% confidence interval [CI], 1.0 to 6.0) and being homeless (OR, 4.1; 95% CI, 1.4 to 12.3) were associated with a change in health-seeking behavior while having a chronic medical condition (OR, 0.2; 95% CI, 0.1 to 0.5) and going to a community clinic for usual care (OR, 0.2; 95% CI, 0.1 to 1.0) were protective. CONCLUSIONS Aggressive debt retrieval for medical care appears to be indiscriminately applied with a negative effect on subsequent health-seeking behavior among those least capable of navigating the health system.
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Affiliation(s)
- Thomas P O'Toole
- Johns Hopkins University Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Balitomore, MD 21205, USA.
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