Medical debt: A prescription for poor patient health?

By Jules Murtha | Fact-checked by Barbara Bekiesz

Published December 7, 2022

Key Takeaways

Research shows that 10.8% of adults carried medical debt between 2017 and 2019.
Loss of insurance coverage and poorer health status are both risk factors for falling into medical debt.
To help patients avoid medical debt, doctors can counsel them to review their insurance policies, practice good recordkeeping, negotiate bills, and seek financial assistance if needed.

The stress of dealing with medical debt weighs heavily on many patients, as physicians may be well aware. But are there long-term health consequences associated with acquiring medical debt?

The answer is yes, according to research. Mental health problems, early mortality, and risk of housing and food insecurity are all potential consequences related to the burden of medical debt.

Doctors can help patients avoid medical debt by encouraging them to develop good financial practices with their medical bills.

Who has medical debt?

The Consumer Financial Protection Bureau (CFPB) reported $88 billion in medical debt on consumer credit records as of June 2021—a figure that doesn’t count the medical debts that consumer reporting companies don’t see.^[]

Authors of a 2022 study published by JAMA Network Open examined the relationship between medical debt and changes in social determinants of health, using data from 2017 to 2019.^[]

During those years, 10.8% of adults had medical debt; the rate was 10.5% among people with private insurance, and 9.6% among those living in Medicaid-expansion states. Over the 3-year span, individuals who lost their health insurance coverage or whose health status had decreased were at a significantly higher risk of acquiring medical debt.

Furthermore, according to the JAMA Network Open research, individuals in medical debt had a “1.7-fold to 3.1-fold higher risk of worsening housing and food security.”

These results point to the effect of medical debt on social determinants of health.

Impact of medical debt on health

Other sources speak to more specific health struggles faced by those who’ve acquired medical debt.

The CFPB report stated that those who have consistent medical debt over the course of their lives are 76% more likely to suffer from chronic pain. Individuals encumbered with medical debt are also more likely to die younger.

Medical debt can pose a real threat to mental health. Patients are three times as likely to develop depression, anxiety, and stress as a result of carrying medical debt.

In addition, people with unpaid medical bills may forgo seeking medical care to avoid high costs that will only add to their financial distress.

The JAMA study results and CFPB report findings paint a grim picture for those who’ve accrued medical debt. But there are measures people can take to prevent the buildup of medical debt before it can cause major damage.

How patients can avoid medical debt

Although there are a number of consequences patients may encounter as a result of medical debt, there are a few actions they can take to avoid it altogether.

According to an article published by the CFPB, the following advice can help patients steer clear of medical debt:^[]

Know your insurance. Familiarize yourself with what your insurance covers (and what it doesn’t). Get an estimate from your insurer about a specific procedure or test, and if it’s not covered, see if there’s an alternative that is. This can mitigate out-of-pocket costs right off the bat.
Keep good records and review bills. Record and organize medical bills and explanations of benefits for your insurance policy. Before paying bills, read them carefully and verify the provider and date of service. Check for any services you may not realize that you received.
Negotiate your bill. If you offer to pay the full bill upfront, hospitals or doctor’s offices may lower the overall cost. If they offer a cash or prompt-payment discount, you may ask for the insured rate. Or you may be able to pay in installments with little to no interest. Be sure to get your repayment plan in writing.
Act quickly. Keep your credit score up by paying your bills quickly. Verify that the amount is correct and pay it immediately. If you can’t pay in full, establish a payment plan. If you need to dispute a bill, do it as soon as possible.
Seek financial assistance. If you can’t pay your bill, there are usually options for financial assistance that you can explore. Some healthcare institutions offer “charity care” programs. If needed, there may be a deadline for enrolling in these programs, so ask about this prior to getting treatment—or immediately after.

What this means for you

Medical debt is associated with the loss of insurance coverage, as well as a significantly increased risk of housing and food insecurity. The stress of medical debt may lead to chronic pain, early mortality, mental health disorders, and avoidance of medical care. To help patients avoid medical debt, doctors can remind them to get familiar with their insurance plan, keep medical records, and negotiate their bills whenever possible.