Problems Paying Medical Bills Increase for U.S. Families Between 2003 and 2007
1 in 5 Americans Faced Medical Bill Problems in 2007, up from 1 in 7 in 2003
Sept. 24, 2008
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WASHINGTON, DCThe proportion of Americans in families
with problems paying medical bills increased to 19.4 percent in 2007, up from
15.1 percent in 2003, according to a national study released today by the Center
for Studying Health System Change (HSC) and funded by The Commonwealth Fund.
The growth translates to more than 57 million Americans in families with medical
bill problems in 2007an increase of 14 million people since 2003, according
to findings from HSCs 2007 Health Tracking Household Survey, a nationally representative
survey with information on 18,000 people; the survey had a 43 percent response
While rates of medical bill problems remained stable for elderly Americans,
more nonelderly insured and uninsured people, alike, faced medical bill problems
in 2007, the study found. And, although the rate of medical bill problems is
much higher for uninsured people, most people with medical bill problems42.5
millionhyad insurance coverage,
"Increases in problems paying medical bills are affecting not only those
who have always struggled with medical costslow-income and uninsured peoplebut
also an increasing number of insured middle-income families," said study
author Peter J. Cunningham, Ph.D., an HSC senior fellow.
About 2.2 million people with medical bill problems were in families that filed
for bankruptcy as a result of their medical bills, and a much larger number
reported other financial consequences, such as problems paying for food and
housing. Likewise, people with medical bill problemsboth insured and uninsured
reported much higher levels of unmet medical needs in the previous year because
of costs compared with people without medical bill problems.
"The increase in medical bill problemsespecially among insured peopleis
the main reason why more people reported unmet medical needs because of cost
in 2007 than in 2003," Cunningham said.
The studys findings are detailed in a new HSC Tracking ReportTrade-Offs
Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007available
Other key findings include:
- About 60 percent of people reported that medical bill problems resulted
from family members illnesses, while 28.6 percent of bill problems were related
to an accident or injury. About 8 percent of people reported that their medical
bill problems were caused by the birth of a child.
- The uninsured nonelderly were more likely to be in families with medical
bill problems (34.4%) compared with insured nonelderly people (18.3%). Among
enrollees in Medicaid or other state coverage programs, 28.4 percent reported
medical bill problems.
- The proportion of Americans with medical bill problems increased across
all income levels between 2003 and 2007, including those with moderate and higher
family incomes. Overall, the percentage of people with medical bill problems
was higher among low-income people-31.8 percent in 2007 for those with incomes
less than 200 percent of poverty, or $41,300 for a family of four in 2007, compared
to 12.4 percent for people in families with incomes of 400 percent of poverty
- The higher rate of low-income people with medical bill problems reflects
both a higher proportion of low-income people who are uninsured and the fact
that insurance coverage appears to make less of a difference in the rate of
medical bill problems for low-income people. Among low-income people, 36.1 percent
of the uninsured reported medical bill problems compared with 30 percent of
the insured. For higher-income people, the uninsured were three times as likely
to report medical bill problems (32.3%) compared with the insured (10.7%).
- The amount of medical debt varied considerably, ranging from about one-fourth
with debt of less than $800 to one-fourth with debt of about $5,000 or more.
About 10 percent had debt of $12,000 or more.
- In both 2003 and 2007, the majority of people in families with problems
paying medical bills were compelled to make difficult sacrifices as a result,
including two-thirds with problems paying for other necessities, such as food,
clothing, mortgage or rent, and more than half putting off major purchases.
Other financial consequences included 62 percent being contacted by a collection
agency, and more than half borrowing money to pay medical bills.
- Among people who reported problems paying medical bills, more than half
reported that their health care providers suggested a payment plan to pay off
the bills. Much less frequently reported actions included providers offering
a discount (16.2%), informing patients about sources of free care (6.8%) and
public assistance (14.6%), suggesting that patients take out a loan (11.5%),
and referring patients to another provider (7.1%).
- When the association of these provider assistance measures with unmet
medical needs was examined, only one of these actionsbeing informed about sources
of free carewas associated with a lower level of unmet medical needs because
of cost. Among those who were informed by their provider about sources of free
medical care, 9.2 percent reported unmet medical needs because of cost compared
with 14.7 percent of all people with medical bill problems.
The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded principally by
the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy