Chronic diseases, not just cancer and diabetes, are increasing the US medical debt

A pre-pandemic study examines the effects of heart disease, asthma and more.

Cancer and diabetes aren’t the only diseases that contribute to medical debt that can lead to personal bankruptcies for patients.

Asthma, heart disease, lung disease, anxiety and other mood disorders — chronic conditions that primary care doctors can help treat — all contribute to patient costs, according to a new study.

“The important finding here is that medical debt is associated with a wide range of chronic conditions,” lead author Dr. Irina Grafova said in a press release. Grafova is an assistant professor in the School of Public Health at Rutgers University. “The other important finding is that this association between chronic disease and medical debt exists at all income levels. It is not limited to lower income households. This is also true for middle- and higher-income households, so it’s really a problem for the whole of society.”


“Illness and Debt: Findings from the 2019 Panel Study of Income Dynamics in the United States,” published in Preventive medicine, examined data on income, health status, and medical debt from 9,174 households. Respondents reported whether they had diabetes, cancer, heart disease, chronic lung disease, asthma, arthritis, anxiety or mood disorders, or health behaviors such as smoking and heavy drinking.

Households were classified according to income levels below, near, or above the US Census Bureau poverty thresholds. The study looked at any medical debt and households with at least $2,000 in debt, the amount at which serious financial problems often begin, according to the researchers.

The survey found that 8.74 percent of lower-income households had medical debt, with 5.82 percent having at least $2,000 in debt. The conditions most strongly associated with debt are heart disease, asthma, and anxiety disorders.

In middle-income households, 9.7% had medical debt and 6.46% had more than $2,000. Diabetes, lung disease, and mood disorders are the most to blame.

For higher-income households, 4.6% reported medical debt, and 3.05% had more than $2,000. Cancer, lung disease, arthritis and mood disorders are the main drivers of medical debt.

Effects of the pandemic?

Grafova noted that the data is from the Panel Study of Income Dynamics national questionnaires sent before the COVID-19 pandemic, which could affect the 2021 results.

“The pandemic itself and our response to it was so massive and multifaceted that it was impossible to predict,” Grafova said. “Did COVID-related health care costs and higher unemployment increase medical debt, or did stimulus payments and reduced spending on things like restaurants and vacations allow Americans to reduce their medical debt?” We don’t know the answers yet, but we should soon.

Debt levels are rising

The study says research is just beginning on the health conditions and behaviors that create medical debt.

What is clearer is that leading up to the pandemic, medical debt in the United States was skyrocketing. In 1981, 8 percent of bankruptcies were related to health care costs, but from 2013 to 2016, about two-thirds of bankruptcies were related to health care, the study said.

Medical debt accounts for 58 percent of third-party debt collections, and nearly 20 percent of the U.S. population now has medical debt in collections, the study said.

Health care providers have created financial navigation interventions to help patients understand out-of-pocket costs, payment plans, cost-saving methods, and access to cancer and diabetes services. More are needed for other health conditions, the study says.

“There is an urgent need for policy and health services interventions to address medical debt in a wider range of disease contexts than previously anticipated,” the study said.

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