1 in 5 households has medical debt. This includes people with private insurance.

Medical debt prevents many people in the United States from buying groceries or paying their mortgages – even among the insured, study published Friday found.

The researchers say the findings, published in the journal JAMA Network Open, provide further evidence that medical debt is a driver of health and financial inequity in America, and underscore the need for policy reform.

“The kinds of things we saw in our study are virtually non-existent in most other wealthy countries,” said the study’s lead author, David Himmelstein, a professor at Hunter College’s CUNY School of Public Health. New York. The United States needs a “real big change”.

People with medical debt are “much more likely to be evicted, much more likely to be unable to pay their utilities, and much more likely to be food insecure,” Himmelstein said.

The study analyzed three years of data from the Sincome and program participation surveysa survey conducted by the US Census Bureau that aims to provide information on US household incomes.

Researchers found that while uninsured people were at the highest risk of recovering medical debt, it was also common among people with private insurance, particularly those with high-deductible plans or those with Medicare Advantage, a type of private insurance plan that provides Medicare benefits.

“Even if you have what most of us would consider good insurance, you could still be liable for huge bills,” Himmelstein said.

Among 136,000 adults surveyed from 2017 to 2019, about 10.8% had medical debt, including 10.5% of adults with private insurance, according to the report.

Women (about 1 in 8) were more likely than men (about 1 in 11) to have medical debt, according to the report.

Nearly one in five households has medical debt, according to the study. Those considered middle class or low income have borne the brunt of the burden. On average, an American household owes about $4,600 in medical debt.

People sign admission forms with a staff member at Children’s Hospital of New York Presbyterian in New York City on May 28, 2021.Diana R. Cabral/NurPhoto via Getty Images File

Additionally, the researchers found that debt was associated with a higher risk of not being able to pay rent or mortgage, being evicted, and being food insecure, even among those with insurance. private.

The research has limitations: US Census Bureau survey data is self-reported and subject to bias. People with Medicare Advantage plans also appear to be underreported in the data.

Still, Lunna Lopes, senior survey analyst for the Kaiser Family Foundation, said the study’s findings appear to be consistent with other studies linking medical debt to poorer health and financial outcomes.

She published a report in June which found that uninsured adults, women, blacks and Hispanics, parents, and low-income people are especially likely to say they have health care debt.

Most people are often responsible for medical debt due to a rare life event, she said, such as a hospital stay due to a car accident. They often have to make sacrifices, such as finding a second job or reducing their daily expenses.

“Food was a question that came up quite frequently when we asked people to be selective about how much and what they bought,” she said.

Himmelstein said there’s not much people can do from an individual standpoint to settle their medical debt.

People might “ask the price before getting the care, but in many cases you still have to get the care even if you can’t really afford it,” he said.

Experts agree there is no simple solution to the US medical debt crisis

“Medical debt is complex and requires a myriad of health and economic policy approaches,” said Allison Sesso, president of RIP Medical Debt, a nonprofit group that uses donations to pay medical bills.

Sesso advocates for federal policies that would address the high cost of premiums as well as the high deductibles and copays that often leave people in debt.

Arthur Caplan, the head of the medical ethics division at NYU Langone Medical Center, recommended that states create a “catastrophic health fund” that would help bail out families with massive medical debts.

For those outside the United States, the answer seems simple.

The most “obvious” policy the United States could implement is universal health coverage without copayments, similar to what is seen in the majority of European countries, said Robert Yates, political economist at the Health and Executive Director of the Center For Universal Health in Chatham. Home in the UK.

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John A. Bogar