Even people with health insurance often defer care because of medical debt, a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health found.
"Avoiding routine or preventive care can worsen patient health conditions, ultimately making them more costly to address -- for patients, insurers and taxpayers who subsidize much of the medical care in the United States," said Catherine Ettman, Ph.D., an assistant professor at the Bloomberg School's Department of Health Policy and Management.
The prevalence of deferral varied by type of care:
- Forty-two percent of people with medical debt delayed dental care, compared with 18% of those without debt.
- Twenty-three percent of people with medical debt delayed medical care vs. just 5.3% of those without.
- Fourteen percent of people with medical debt delayed mental health care, compared with 5% of those with no debt.
More than 10% of the nearly 30,000 adults who participated in the survey reported experiencing medical debt, defined as experiencing problems paying or being unable to pay any medical bills in the past 12 months. This includes bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home care.
Uninsured adults were more likely to defer medical care when experiencing medical debt than those covered by commercial insurance coverage provided by private, non-government companies. More than 19% of uninsured adults, 13% of adults with Medicaid, 9% with commercial insurance and 8% with Medicare reported medical debt. The share of deferred care for both mental health and dental needs was comparable among those who are insured and uninsured.
"This study adds to a growing body of research that shows that people facing financial barriers to care experience poorer physical and mental health, higher mortality rates and increased utilization of high-cost resources that could have been averted with preventive and routine care," the report said. "However, previous research has not compared which types of care are most often deferred by people experiencing medical debt."
Although findings remained consistent across insurance types, the association between medical debt and deferred care was significantly higher among uninsured adults than those with commercial insurance.
"Taken together, these results suggest that medical debt contributes to unmet need for treatment across a spectrum of health needs for American adults, regardless of insurance coverage," the report said.
The results also suggest that dental care might be the most sensitive to medical debt, in part because it is not always included in health insurance plans but often requires additional insurance that typically has limited coverage.
"People who put off care at a minimum risk missing prevention opportunities and recommended monitoring," the report concluded. "Delaying care can also put people at risk for developing conditions down the road. For instance, poor dental health is linked to heart disease, cognitive decline and other serious conditions."
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