Financial Hardship Due to Medical Bills and Delaying or Not Receiving Needed Health Services: Two-Year Panel Study

Purpose: Accessing medical care when needed is important for timely detection and treatment of health conditions. Moreover, it will save healthcare costs in the long run. However, for many individuals, the ever-increasing out-of-pocket healthcare costs work as a major barrier to accessing adequate healthcare. With the two-year panel data, the current study assessed the percentage of the U.S. adults (26+) who experienced financial difficulties due to medical bills and tested whether such financial hardship due to out-of-pocket healthcare costs was associated with delaying or not receiving care in the following year after controlling for other covariates including healthcare needs, health insurance status, household poverty status, and the amount of out-of-pocket healthcare expenditures.     

Methods: The 2011 National Health Interview Survey (NHIS) was linked to the 2012 Medical Expenditure Panel Survey (MEPS). The respondent was considered to have financial hardship due to medical bills in 2011 if the respondent or anyone in the family: (1) had problems paying medical bills in the past 12 months, (2) currently had medical bills that they were unable to pay at all, or (3) currently had any medical bills that were being paid off over time (yes/no). The dependent variable, access to healthcare, was assessed with the questions in the 2012 MEPS that asked whether the respondent delayed or could not receive necessary medical care, dental care, or prescription drugs in 2012. The sample includes 10,461 individuals aged over 26. The STATA SVY procedures were used for descriptive statistics and logistic regression models to account for the complex sampling design of the NHIS and MEPS.       

Results: About one third (31%) of the respondents or their families experienced difficulty paying medical bills. More specifically, 25% had medical debt they were paying off, 19% had experienced difficulties paying medical bills in the past 12 months, and 10% had the current medical bills that they were unable to pay at all. Strikingly, 28% of the adults with health insurance experienced financial hardship due to out-of-pocket healthcare costs, although the rate was lower than that among the uninsured (48%). Regarding access to care in year 2, 13% of the respondents reported either delayed or unused medical treatments. The multivariate results indicate that those experiencing financial hardship from medical bills in 2011 were significantly more likely to delay or not use necessary health care in 2012 (Odd Ratio [OR] =1.8, p<.0001) compared with those not experiencing financial hardship, after controlling for other covariates including their perceived and diagnosed health status, income, and out-of-pocket healthcare costs in 2012.

Implications: It is alarming that 31% of the U.S. adult population are affected by financial constraints caused by medical bills, and such financial hardship hinders their seeking necessary health services even during the following year. Considering the various adverse consequences of untreated health conditions and the high prevalence of the financial hardship resulting from medical bills, policy and program alternatives should be explored to provide affordable financing programs and adequate safety-net health services for those who are vulnerable.