Report: Chronic diseases lead to medical debt at all income levels - MedCity News

Medical debt — which often results from expensive ongoing treatment provided for chronic conditions — is the leading cause of personal bankruptcy in the U.S., according to National Consumer Law Center.

Medical debt is often associated with cancer and, more recently, diabetes treatment. However, there are other chronic conditions that contribute significantly to the medical bills of American patients, according to a new study published in Preventive medicine. Some of these conditions include heart disease, asthma, anxiety and lung disease.

Researchers from Rutgers University analyzed data from 9,174 households participating in the 2019 wave A panel study of income dynamics, the world’s longest running longitudinal household survey. They categorized households by income levels, using the 2019 federal poverty line as a guide — the threshold for a family with two adults and one child was $20,578.

The research team used three categories of household income: lower (less than twice the census poverty line), middle (two to four times the threshold) and higher (more than four times the threshold). The research team then calculated the relationship between 11 chronic conditions and reported medical debt.

The study found that treating chronic conditions contributes to medical debt at all income levels. The medical debt rate was 8.74% in lower-income households, 9.77% in middle-income households, and 4.6% in higher-income households.

Previous research has identified $2,000 as the amount of debt at which serious financial problems often occur, according to the study. The Rutgers team found that medical debt exceeded that amount in 5.82 percent of lower-income households, 6.46 percent of middle-income households, and 3.05 percent of higher-income households.

There are several pathways by which Americans accumulate medical debt related to chronic diseases, Irina Grafova, the study’s lead author and an assistant professor at the Rutgers School of Public Health, said in an interview. The first occurs when an individual’s chronic condition prevents them from working at their full potential. For example, someone with severe anxiety may not be able to work as many hours as their colleagues, and a person with asthma or lung disease may not be able to work in a job that requires frequent walking.

“If you have a lower income because of your chronic health condition, that means less money to pay the bills,” Grafova said.

The other factor is out-of-pocket spending. Grafova pointed out that all patients in the U.S. who are being treated for chronic conditions will face out-of-pocket medical costs, regardless of their insurance status. Not surprisingly, the burden will be felt most among the uninsured and those whose health plans have high out-of-pocket maximums.

The study found that the chronic conditions most strongly associated with medical debt differed by household income levels. These conditions are heart disease, asthma, and anxiety disorders for lower-income households; diabetes, lung disease, and mood disorders for middle-income households; and cancer, lung disease, arthritis, and mood disorders for higher-income households.

More research is needed to determine why certain chronic diseases affect people financially differently depending on their household income, Grafova said. In fact, medical debt in the U.S. as a whole is a topic that researchers need to pay more attention to, she argues.

Most studies of medical debt look only at unpaid medical bills, according to Grafova. When people pay their medical bills by credit card, researchers typically treat those costs as “paid,” even though those credit card charges can create debt that can haunt patients for years.

“We probably really underestimate the medical debt,” Grafova said. “Many people pay medical bills with credit cards. And if they do, they’re not even part of our outcome variable.

Source: erdikocak, Getty Images

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