文章基本信息

标题：Health Insurance Status, Medical Debt, and Their Impact on Access to Care in Arizona
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作者：Patricia M. Herman ; Jill J. Rissi ; Michele E. Walsh 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：8
页码：1437-1443
DOI：10.2105/AJPH.2010.300080
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the impact of health insurance status on medical debt among Arizona residents and the impact of both of these factors on access to care. Methods. We estimated logistic regression models for medical debt (problems paying and currently paying medical bills) and access to care (medical care and medications delayed or missed because of cost or lack of insurance). Results. Insured status did not predict medical debt after control for health status, income, age, and household characteristics. Insured status (adjusted odds ratio [AOR] = 0.32), problems paying medical bills (AOR = 4.96), and currently paying off medical bills (AOR = 3.04) were all independent predictors of delayed medical care, but only problems paying (AOR = 6.16) and currently paying (AOR = 3.68) medical bills predicted delayed medications. Inconsistent coverage, however, was a strong predictor of problems paying bills, and both of these factors led to delays in medical care and medications. Conclusions. At least in Arizona, health insurance does not protect individuals from medical debt, and medical debt and lack of insurance coverage both predict reduced access to care. These results may represent a troubling message for US health care in general. Financial hardship caused by out-of-pocket medical expenses is a large and growing problem in the United States. In 2007, it was estimated that 19% of the population had problems paying medical bills (up from 15% in 2003).¹ Another 2007 study estimated that 41% of the population aged 19 to 64 years had problems paying medical bills, had accrued medical debt, or both.^{2 , 3} That estimate was up from 34% in 2005. Health insurance coverage should protect individuals from medical debt. However, in contrast with most insurance products, which indemnify losses stemming from low-probability and high-consequence events, health insurance plays the dual role of promoting actions to prevent such events and protecting against loss from them. Furthermore, in the United States health insurance rarely provides complete protection against financial loss caused by illness or injury. Rather, increasing portions of medical costs are paid directly by the insured in the form of copayments, deductibles, exclusions and limits on covered benefits, coinsurance provisions, and lifetime spending caps. In fact, a substantial portion of individuals both insured and uninsured, as well as individuals across a wide range of ages and income levels, have reported that paying medical bills is a problem.^{1 – 6} At least to some extent, medical debt is also more damaging than are other types of consumer debt because medical bills are often incurred through an illness or injury that limits one's ability to work. Specifically, problems paying medical costs are associated with higher credit card debt,⁷ more calls from bill collectors,⁷ increased bankruptcy rates,^{7 – 10} and diminished access to care.^{1 , 4 – 6 , 11 , 12} We took advantage of a large health-related data set to examine medical debt and its consequences in Arizona. Because substantial national attention has been devoted to reducing the ranks of the uninsured in an attempt to improve access to care,^{13 – 16} we particularly focused on estimating the impact of health insurance status on the prevalence of debt and the impact of both of these factors on access to care.