Admission for traumatic injury associated with higher medical debt, bankruptcy filings
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Published results showed an association between admission for traumatic injury with higher rates and amounts of medical debt in collections and a doubling of bankruptcy filings among commercially insured working-age adults.
Researchers used coarsened exact matching of age, sex, calendar quarter of admission and ZIP code social vulnerability index to compare 3,165 working-age adults whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury with 2,223 patients admitted between January 2021 and December 2021 for traumatic injuries after their January 2021 credit report. Researchers included any delinquent debt, medical and nonmedical debt in collections, bankruptcy filings in the past 2 years and credit score as financial outcomes.
Results showed 23.8% of patients in the postinjury cohort had medical debt in collections vs. 19.3% of patients in the comparison cohort. Researchers also found patients in the postinjury cohort had a 70% higher amount of medical debt in collections and a 110% higher bankruptcy rate. Researchers noted the two groups had no significant differences in credit scores or amount of nonmedical debt in collections.
“One policy solution to mitigate financial distress after health shocks is to reduce or eliminate cost sharing for conditions not subject to overuse, such as traumatic injury requiring prolonged hospitalization,” the authors wrote. “Another alternative is to establish means-based deductibles, which could reduce the burden of [out-of-pocket] OOP spending relative to income so that patients are not forced to choose between delaying care and defaulting on debt. State, community or hospital programs that reduce financial barriers to postdischarge care may help mitigate affordability-induced delays to obtaining clinical care needed for optimal long-term recovery.”
Perspective
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Anna N. Miller, MD, FAAOS, FACS, FAOA
Socioeconomic disparities in health care are an issue that causes an underappreciated societal burden on the U.S. population. The current study shows that patients with unexpected medical issues had higher medical debt in collections and twice as many bankruptcy filings, even though they were commercially insured. We can only speculate how much more this would affect those without insurance. Even in Canada, where the government ensures health care for all, Galabuzi and colleagues wrote, "Ill health has emerged as one of the main reasons cited by individuals as the cause of their household’s poverty." This may lead to a self-fulfilling cycle where low socioeconomic status causes poorer health, which itself may further lower that status. In addition, many households suffer “net worth poverty,” as Gibson-Davis and colleagues wrote, where income can be sensitive to unexpected shocks, such as acute health crises. Hospitals can contribute to this by committing "to ceasing activities that can directly reduce individual economic security, including the imposition of medical debt and the use of aggressive bill-collecting practices." We should seek to implement some of the recommendations by the authors to ensure that patients get the care they need without ruining their lives.
References:
Galabuzi GE. Canada’s creeping economic apartheid: The economic segregation and social marginalization of racialized groups. http://tdrc.net/resources/public/economicapartheid.pdf. Published May 2001. Accessed Nov. 21, 2022.
Gibson-Davis C, et al. J Marriage Fam. 2021;doi:10.1111/jomf.12742.
South E, et al. N Eng J Med. 2022;doi:10.1056/NEJMms2209521.
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