Medical Debt Linked to Worsening of Food, Housing Insecurity

Stethoscope on 100 dollar bills symbolizing financial surveillance
isk factors for medical indebtedness include hospitalization, disability, high deductible, Medicare Advantage, and no insurance coverage.

HealthDay News — Medical debt is common and is a risk factor for worsening of food and housing insecurity, according to a study published online Sept. 16 in JAMA Network Open.

David U. Himmelstein, M.D., from the City University of New York at Hunter College in New York City, and colleagues assessed the prevalence of and risk factors associated with medical debt and the association of medical debt with subsequent changes in food and housing security. The analysis included responses from U.S. participants in the Surveys of Income and Program Participation (51,872 in 2017; 40,784 in 2018; and 43,220 in 2019).

The researchers found that 10.8 percent of individuals and 18.1 percent of households carried medical debt. Rates were similar among persons with low and middle incomes. The mean medical debt in 2018 was $21,687 per debtor. Risk factors associated with medical indebtedness included hospitalization, disability, and having private high-deductible, Medicare Advantage, or no coverage, while residing in a Medicaid-expansion state was protective (2019: odds ratio [OR], 0.76). Losing insurance coverage between 2017 and 2019 was associated with acquiring medical debt by 2019 (OR, 1.63), as was becoming newly disabled (OR, 2.42) or newly hospitalized (OR, 2.95). Acquiring medical debt between 2017 and 2019 was a risk factor for becoming food insecure (OR, 2.20), losing ability to pay rent or mortgage (OR, 2.29), losing ability to pay utilities (OR, 2.37), and eviction or foreclosure (OR, 2.95) in 2019.

“Results of this study suggest that medical indebtedness is common, even among the insured, and may be associated with subsequent worsening of social determinants of health,” the authors write.

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