Prevalence and Correlates of Medical Financial Hardship in the USA.
Level 4 - case-series / case-control
Cross-sectional survey analysis of nationally representative observational data
PubMed 31044413 · doi:10.1007/s11606-019-05002-w
What was done
Using data from the 2015–2017 National Health Interview Survey (NHIS), researchers evaluated the national prevalence and correlates of three domains of medical financial hardship: material conditions (e.g., medical debt), psychological distress, and behavioral coping (e.g., forgoing care due to cost). Analyses were cross-sectional, multivariable, and stratified by age: 18–64 years (n = 68,828) and ≥65 years (n = 24,614).
What was found
An estimated 137.1 million US adults (95% CI, 132.7–141.5) reported any medical financial hardship in the past year. Adults aged 18–64 experienced higher rates than adults ≥65 across all domains: psychological distress (46.9% vs. 28.4%), material hardship (28.9% vs. 15.3%), and behavioral coping (21.2% vs. 12.7%; all p < .001). Lower educational attainment and greater numbers of chronic health conditions were strongly associated with hardship intensity in both cohorts (p < .001). Among adults aged 18–64, multiple domains of hardship were reported by 52.8% of uninsured individuals compared to 26.5% with public and 23.2% with private insurance (p < .001). Among older adults, 17.1% with Medicare alone reported multiple hardship domains compared to 12.1% with Medicare plus public coverage and 10.1% with Medicare plus private coverage (p < .001).
Why it matters
This study provides nationally representative estimates demonstrating that medical financial distress affects over half of non-elderly uninsured adults and remains common even among insured and older populations.
Limits
The cross-sectional survey design precludes causal conclusions. All measures were self-reported and subject to recall bias, and the abstract does not report clinical severity or specific out-of-pocket dollar amounts.