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Medical debt has often been associated with cancer and, more recently, the treatment of diabetes. However, there are other chronic diseases that contribute significantly to medical bills for American patients, according to a new study Posted in Preventive medecine. Some of these conditions include heart disease, asthma, anxiety, and lung disease.
Researchers from Rutgers University analyzed data from 9,174 households that participated in the 2019 wave of the Panel study of income dynamics, the oldest longitudinal household survey in the world. They categorized households by income levels, using the 2019 federal poverty line as a guide — the threshold for a family with two adults and one child was $20,578.
The research team used three categories of household income: low (less than twice the census poverty line), middle (two to four times the line), and high (more than four times the line). The research team then calculated the relationship between 11 chronic conditions and reported medical debt.
The study found that chronic disease treatment contributed to medical debt at all income levels. Medical debt rates were 8.74% in low-income households, 9.77% in middle-income households, and 4.6% in high-income households.
Previous research has identified $2,000 as the amount of debt where serious financial problems often arise, according to the study. The Rutgers team found that medical debt exceeded this amount in 5.82% of low-income households, 6.46% of middle-income households, and 3.05% of high-income households.
There are several pathways by which Americans accumulate chronic disease-related medical debt, Irina Grafova, the study’s lead author and assistant professor at the Rutgers School of Public Health, said in an interview. The first occurs when a person’s chronic condition prevents them from working to their full potential. For example, a person with severe anxiety may not be able to work as many hours as their colleagues, and a person with asthma or lung disease may not be able to perform work that requires to walk frequently.
“If you have a lower income because of your chronic illness, that means less money to pay the bills,” Grafova said.
The other factor is personal expenses. Grafova pointed out that all American patients who receive treatment for chronic conditions will face medical costs, regardless of their insurance status. Unsurprisingly, the burden will be felt most among the uninsured and those whose health plans have high caps.
The study found that the chronic conditions most strongly associated with medical debt differed by household income levels. These conditions were heart disease, asthma and anxiety disorders for low-income households; diabetes, lung disease and mood disorders for middle-income households; and cancer, lung disease, arthritis and mood disorders for high-income households.
More research is needed to determine why certain chronic conditions affect people financially differently based on their household income, Grafova said. In fact, medical debt in the United States more generally is something researchers should focus on more, she argued.
Most studies of medical debt only look at unpaid medical bills, according to Grafova. When people pay their medical bills by credit card, researchers typically treat those expenses as “paid,” even though those credit card charges can create debt that can haunt patients for years.
“We’re probably really underestimating medical debt,” Grafova said. “A lot of people pay their medical bills using credit cards. And if they do, they’re not even part of our result variable.
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