Medical debt occurs despite insurance, UA study shows

Tucson, Ariz. - Health insurance is not protecting Arizonans from having problems paying medical bills, and having bill problems is keeping families from getting needed medical care and prescription medicines, a new study has found.

According to a study published online June 16, 2011, by the American Journal of Public Health, after taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications. In addition, says University of Arizona College of Pharmacy research scientist Patricia M. Herman, ND, PhD, who directed the study, medical debt is a separate and better predictor of whether people will delay or forego needed medical care than their insurance status.

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt," Herman says. "From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."

The study analyzed data from more than 2,300 cases included in the Arizona Health Survey, a comprehensive survey of 4,200 Arizona households designed to assess insurance coverage, health status, behaviors and social and environmental factors that affect health. The health survey was conducted in 2008, before the full impact of the nation's recent financial recession and high unemployment.

Because individuals 65 and over have access to Medicare, the study focused on adults age 18 to 64. Researchers used logistic regression models to examine predictors of medical debt, including insurance status, and the relative impact of medical debt and insurance status on subjects' decisions to obtain needed health care or prescribed medicine.

Herman's analysis determined that the continuity of health insurance coverage is an important factor in both debt problems and seeking medical care. "People who experience coverage gaps are more than twice as likely to report problems paying medical bills, and are six times as likely to report delayed care," she says.

Among the implications of the findings, Herman says, are that health insurance should be portable, universally available, or both, so that families do not experience coverage gaps, and that serious efforts are needed to reduce large out-of-pocket costs to insured patients, to reduce medical debt.

Co-authors of the study are Michele Walsh, PhD, of the University of Arizona Norton School of Family and Consumer Sciences, and Jill Rissi, RN, PhD, of the Portland State University Hatfield School of Government. The study was funded by St. Luke's Health Initiatives, a Phoenix-based public foundation focused on Arizona health policy and strength-based community development.

Other background for reporters:

• Arizona residents surveyed in 2008 appear to have been somewhat better off than citizens in other states. In 2008, 29 percent of Arizonans reported medical bill problems, debt or both, compared to 41 percent of the 19-64 age group nationally.

• In 2008, the total amount of current medical bills being paid off by Arizonans totaled $2.4 billion. This equated to an average of about $500 per each adult in the state at the time.

• The odds of medical debt increase when there are children in the household.

About the author: Dr. Herman is an NIH/NCCAM-trained research methodologist, a resource economist, and a licensed practicing naturopathic physician. She has been an economist for 30 years and worked in policy and cost-effectiveness analysis across a number of disciplines, including health care. In this role she was invited to co-author a commissioned paper on the economics of integrative medicine for the Institute of Medicine's Summit on Integrative Medicine and the Health of the Public, has served on National Institute of Health review panels, and was an invited speaker at the Office of Dietary Supplements' workshop on the Economic Analysis of Nutrition Interventions: Methods, Research and Policy. Her training and experience in research methodology includes statistics, biostatistics, epidemiology, econometrics, psychometrics, and program evaluation as well as general and whole systems research design and health services research methods. Her research interests focus on how health is valued as a personal and as a national resource. To this end she has examined health behaviors (e.g., tobacco use) and their effect on health, health insurance and its impact on access to health care and medical debt, worksite and hospital-based care, and individuals' use of non-conventional medicine.

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