Medical debt is associated with worse health status, more premature deaths, and higher mortality rates in the United States, according to a recent cross-sectional study published by Han et al in JAMA Network Open.
Background
“Patients are increasingly burdened by high out-of-pocket costs for health care in the [United States], including problems paying medical bills and medical debt, but little was known about county-level associations of medical debt with population health,” explained lead study author Xuesong Han, PhD, Scientific Director of Health Services Research at the American Cancer Society (ACS). “Our findings reinforce medical debt as an important social determinant of health, which, unfortunately, may threaten public health in the country,” she added.
Study Methods and Results
Investigators used 2018 data from the Urban Institute Debt in America project, 2018 self-reported health status and premature death data compiled by the County Health Rankings & Roadmaps, and 2015 to 2019 mortality data from the National Vital Statistics System to analyze the outcomes of patients from 2,943 U.S. counties.
On average, 19.8% of the population in a county had medical debt in collections. After adjusting for county-level sociodemographic characteristics, the investigators noted that a 1 percentage point increase in the population with medical debt was associated with 18.3 physically unhealthy days and 17.9 mentally unhealthy days per 1,000 individuals during the past month; 1.12 years of life lost per 1,000 individuals; and an age-adjusted all-cause mortality rate of 7.51 per 100,000 person-years.
Associations between medical debt and elevated mortality rates were consistent for all leading causes of death such as cancer, cardiovascular disease, and suicide. Geographically, the counties with the highest medical debt burden were mostly in the South and Southwest regions of the United States—concentrated in Texas, Louisiana, Georgia, Tennessee, South Carolina, North Carolina, and West Virginia.
Conclusions
“State policies expanding health insurance coverage have been shown to be effective in mitigating medical debt. Also, increasing attention to identifying patients struggling with paying bills in clinical settings and connecting them with financial and other supportive services may also reduce the risk of medical debt,” Dr. Han underscored.
“T[his] study reiterates how the rising cost of health care in the [United States] continues to take a significant toll on patients and their families. With a system that continues to be unaffordable for too many touched by cancer, addressing medical debt is a growing public policy priority among [patients and survivors of] cancer. We need lawmakers at all levels of government to take action to make health care more affordable and address medical debt now,” concluded Lisa Lacasse, MBA, President of the ACS Cancer Action Network.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
