By Sameh N. Saleh, M.D.; Ezimamaka Ajufo, B.M., B.Ch.; Christoph U. Lehmann, M.D.; Richard J. Medford, M.D.
JAMA Network Open, October 26, 2020
Key Points
Question: Why do individuals from Canada, the UK, and the US turn to medical crowdfunding and what factors are associated with funding success?
Findings: In this cross-sectional study of 3396 crowdfunding campaigns designed to raise monetary donations for medical expenses, female gender, Black race, and routine care were associated with a strong fundraising disadvantage. For campaigns primarily funding treatment, routine care was overwhelmingly represented in the US (77.9%), in contrast to Canada (21.9%) and the UK (26.6%), and crowdfunding primarily funding alternative therapies (16.0%) was more common for cancer (23.5%) vs noncancer (6.5%) diagnoses.
Meaning: These findings suggest that there are important differences in the reasons for medical crowdfunding across the 3 countries included in this analysis and that there are racial and gender disparities in crowdfunding success.
From the Discussion
In the US, nearly 80% of campaigns primarily funding treatment were for routine care, whereas in Canada and the UK, funding for routine care was sought about as frequently as funding for alternative, approved but inaccessible, and experimental therapies. Campaigns for routine care were negatively associated with crowdfunding success, whereas campaigns for experimental and approved but inaccessible therapies were positively associated with funding success.
Crowdfunding was initially heralded as a digital safety net or a mechanism for democratizing charity where anyone could benefit. However, anecdotal and empirical evidence suggests that crowdfunding may exacerbate socioeconomic inequities.
Conclusions
We provide a foundational descriptive analysis of MCF and factors associated with success in Canada, the UK, and the US, and highlight important differences in MCF trends between publicly and privately funded health care systems. Our findings also suggest that there are racial and gender disparities in the use and success of MCF. MCF directly (through platforms that promote the victim narrative) and indirectly (by rewarding these narratives with funding success) promotes the myth that gaps in health care funding are due to misfortune and exceptionality, rather than systemic failures. As such, MCF may entrench the systemic failures that led to its need. Thus, although crowdfunding has the potential to provide short-term relief from medical financial burden for a subset of patients, it may carry wider-reaching paradoxical societal effect for those most socially disadvantaged.
Comment:
By Don McCanne, M.D.
Because of the deficiencies in our health care financing system, it is easy to see why some resort to charitable crowdfunding to help pay their medical bills. But why do Canada and the UK use crowdfunding when they have universal financing systems? The differences can give us some insight as to how the respective health care financing systems work.
Crowdfunding in the United States is used more frequently for routine care than it is in Canada and the UK for the obvious reason that their systems work better for covering routine care. In contrast, crowdfunding in Canada and the UK is frequently used for inaccessible or experimental therapies, as might be expected. To no surprise, crowdfunding for routine care is not as successful as it is for inaccessible or experimental services.
Crowdfunding is also used for alternative medicine, especially for cancer, since it is inappropriate to use public funds for care that is unproven and may be unsafe.
Sadly, crowdfunding may also exacerbate socioeconomic inequities because of racial or gender disparities. We would expect that that would be much less common under a truly equitable, universal system, though we would like to see the inequities totally disappear.
When we discuss single payer Medicare for All we frequently specify that it be a well designed system. As such, the system should work even better than those in Canada and the UK, and there should be no need for crowdfunding to pay medical bills. If experimental therapy might be appropriate then that should be funded by NIH research grants until the studies confirm effectiveness and safety.
Whether it’s a tin cup in hand, or crowdfunding in the computer age, that is no way to fund health care. Time for solidarity so we all have the health care we need.
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