Data and Method: Data for this study came from MedPut administrative data for 4,317 employees in 21 companies and organizations who were invited to use MedPut and a survey completed by MedPut enrollees. Survey questions asked about employees' experiences with medical bills and debt, use of health care, general household financial health, and demographic characteristics. Probit regression models using covariance control and robust standard errors with employer as a clustering variable to produce predictive margins to examine registration choice, characteristics of submitted bills, and workers’ financial difficulties and delayed or deferred healthcare due to cost concerns.
Findings: The average age of workers was 42.79 (SD = 12.69). Over a third of employees had salaries below $40,000 and had dependents. Almost a third of workers registered for MedPut, with middle-range salary ($40,000 - $69,999), dependents, and work for a small employer predicting registration choice. Most employees (82%) who used MedPut did so only once; most cases were for past-due accounts (77%). The mean amount of submitted bills was $1,379 (SD = $1,032.09), 37% of which were discounted. Over half (52.46%) of users said they had problems paying a medical bill within the prior 12 months compared to 18.55% of non-users (p < .001). Users were also more likely to put off medical or dental care (63.33%) due to cost concerns compared to 32.79% (p < .001) of non-users.
Significance: This study offers a unique perspective on a social determinant of health – the problems workers with HDHPs have paying for healthcare, especially workers with family coverage. That most bills submitted to MedPut were for delinquent accounts reflects the growing problem of medical debt in the U.S. (Consumer Financial Protection Bureau, 2022) and suggest that healthcare providers are doing a poor job of offering financial assistance such as charity care and no-interest payment plans. Most importantly, that difficulties managing healthcare expenses discourage workers from seeking needed care suggests the need for more significant healthcare reform than has been manifested through the Affordable Care Act.