More than half of Americans face this healthcare problem

An estimated 137 million adults in the United States have this healthcare problem, which causes stress, delays treatment, and impedes your care: It’s medical financial hardship. And it’s worse for adults under age 65 years than for those who are older.

“With recent trends toward increasing prevalence of multiple chronic conditions, higher patient cost-sharing, and increasing costs of healthcare, the risks of financial hardship will likely increase in the future,” wrote researchers led by epidemiologist K. Robin Yabroff, PhD, senior scientific director, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, in a recent article in the Journal of General Internal Medicine.

“Thus, unless addressed, medical financial hardship may become an increasingly common consequence of illness in adults of all ages,” added Dr. Yabroff and coauthors.

Differences by age

Although many researchers have studied the financial tolls of cancer, few have assessed medical financial hardship among the general population.

To that end, the researchers at the American Cancer Society used data from the 2015-2017 National Health Interview Survey to determine the prevalence of three aspects of medical financial hardship:

• Material hardship (problems paying medical bills)
• Psychological hardship (worry about medical bills)
• Behavioral hardship (delaying or forgoing medical care because of cost)

The researchers found that 56% of all US adults experienced at least one aspect of medical financial hardship.

When stratified by age, substantially more adults aged 65 years and older (47.9%) reported having at least three health conditions than adults aged 18-64 years (11.2%). Despite this, adults aged 18-64 years had higher material (28.9% vs. 15.3%), psychological (46.9% vs. 28.4%), and behavioral (21.2% vs. 12.7%) medical financial hardships than adults aged 65 years and older.

In addition, adults aged 18-64 years with lower educational attainment and more health conditions were more likely to report high intensity of hardship. Also, women were more likely than men to report multiple aspects of hardship. And uninsured adults were more likely to report multiple aspects of hardship (52.8%) compared with those with some public (26.5%) and private insurance (23.2%).

Problem likely to get worse

High out-of-pocket medical costs are a critical and increasing problem for American patients, Dr. Yabroff and coauthors noted. High out-of-pocket costs can cause distress and worry about household finances, lead to medical debt, and even wipe out a family’s assets. Due to cost, patients may delay or decline needed medical care, which jeopardizes the benefits of treatment.

On top of that, illness can impact patients’ ability to work, which reduces productivity, limits household income, and potentially cuts off employer-sponsored health insurance coverage in working-age adults.

The researchers predict that unless action is taken, the problem will only get worse.

“With increasing prevalence of multiple chronic conditions, higher patient cost-sharing, and higher costs of healthcare, the risk of hardship will likely increase in the future. Thus, development and evaluation of the comparative effectiveness and cost-effectiveness of strategies to minimize medical financial hardship will be important,” Dr. Yabroff and coauthors wrote.

What can be done?

They pointed to a number of patient-level intervention strategies to reduce financial hardships, including education programs aimed at improving health insurance literacy, screening tools, and financial navigation to link patients to community resources. Other interventions are focused on enhancing doctor-patient discussions about the expected costs and benefits of care.

“Development and evaluation of interventions to minimize financial hardship and adverse health outcomes at the patient, provider, and insurer levels are ongoing,” they wrote.