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Chronic health conditions, not just cancer and diabetes, are pushing up U.S. medical debt


Pre-pandemic survey examines effects of heart disease, asthma, and more.

Chronic health conditions, not just cancer and diabetes, are pushing up U.S. medical debt

Cancer and diabetes are not the only maladies contributing to medical debt that could lead to patients’ personal bankruptcies.

Asthma, heart disease, lung disease, anxiety, and other mood disorders – chronic conditions that primary care physicians can help treat – all add up for patient costs, according to a new study.

“The important finding here is that medical debt is connected to a wide range of chronic conditions,” lead author Irina Grafova, PhD, said in a news release. Grafova is an assistant professor at the Rutgers University School of Public Health. “The other important finding is that this connection between chronic disease and medical debt exists at all income levels. It is not confined to lower-income households. It also holds true for middle-income and higher-income households, so it really is a society-wide issue.”

Going into debt

“Disease and debt: Findings from the 2019 Panel Study of Income Dynamics in the United States,” published in Preventive Medicine, examined data on income, health conditions, and medical debt from 9,174 households. Respondents reported if they had diabetes, cancer, heart disease, chronic lung disease, asthma, arthritis, anxiety disorders, or mood disorders, or health behaviors such as smoking and heavy drinking.

Households were classified by income levels being lower, close to, or greater than U.S. Census Bureau poverty thresholds. The study looked at any medical debt and households with debt of at least $2,000, the amount where serious financial problems often begin, according to the researchers.

The study found 8.74% of lower-income households had medical debt, with 5.82% having at least $2,000 in debt. Conditions most strongly associated with debt were heart disease, asthma, and anxiety disorders.

In middle-income households, 9.7% had medical debt and 6.46% had more than $2,000. Diabetes, lung disease, and mood disorders were the conditions most to blame.

For higher income households, 4.6% reported medical debt and 3.05% had more than $2,000. Cancer, lung disease, arthritis, and mood disorders were the main drivers for medical debt.

Pandemic effects?

Grafova noted the data were from the Panel Study of Income Dynamics national questionnaires sent out before the COVID-19 pandemic, which could affect the 2021 findings.

“The pandemic itself and our response to it were so large and multifaceted that it’s impossible to predict,” Grafova said. “Did COVID-related health care costs and higher unemployment increase medical debt, or did stimulus payments and decreased expenditures on things like restaurants and vacations allow Americans to reduce their medical debt? We still don’t know the answers, but we should know them soon.”

Debt levels soaring

The study said research is just beginning on health conditions and behaviors that create medical debt.

What’s clearer is that leading up to the pandemic, medical debt was skyrocketing in the United States. In 1981, 8% of bankruptcies were related to health care expenses, but by the period 2013 to 2016, about two-thirds of bankruptcies were tied to health care, the study said.

Medical debt accounts for 58% of third-party debt collections, and almost 20% of the U.S. population now has medical debt in collections, the study said.

Health care providers have set up financial navigation interventions to help patients understand out-of-pocket expenses, payment plans, cost-saving methods, and access to services for cancer and diabetes. More are needed for the other health conditions, the study said.

“There is an urgent need for policy and health services interventions to address medical debt in a wider range of disease contexts than heretofore envisioned,” the study said.

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Michael J. Barry, MD