• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

PNHP

  • Home
  • Contact PNHP
  • Join PNHP
  • Donate
  • PNHP Store
  • About PNHP
    • Mission Statement
    • Board of Directors
    • National Office Staff
    • Speakers Bureau
    • Local Chapters
    • Students for a National Health Program
    • Contact Us
    • Privacy Policy
  • About Single Payer
    • What is Single Payer?
      • Policy Details
      • FAQs
      • History of Health Reform
      • Información en Español
    • How do we pay for it?
    • Physicians’ Proposal
      • Full Proposal
      • Supplemental Materials
      • Media Coverage
    • The Medicare for All Act of 2025
  • Take Action
    • Moral Injury and Distress
    • Medical Society Resolutions
    • Recruit Colleagues
    • Schedule a Grand Rounds
    • Letters to the Editor
    • Lobby Visits
    • Organizing in Red Districts
  • Heal Medicare
    • HealMedicare.org
    • Sign our Petition
    • Take our Survey
    • Medicare Disadvantage
    • Stop REACH
  • Kitchen Table Campaign
    • Medicare Disadvantage
    • Maternal Mortality
    • Mental Health Care
    • Health Care Voters Guide
    • COVID-19 Endangers Health Workers
    • COVID-19 Exacerbates Racial Inequities
    • Public Health Emergencies
    • Rural Health Care
    • Racial Health Inequities
    • Surprise Billing
  • Latest News
    • Sign up for e-alerts
    • Medicare Advantage harms report
    • Members in the news
    • Health Justice Monitor
    • Articles of Interest
    • Latest Research
    • For the Press
  • Member Resources
    • 2024 Annual Meeting Materials
    • Newsletter
    • Slideshows
    • Materials & Handouts
    • Kitchen Table Campaign
    • COVID-19 Response
      • Why we Need Medicare for All
      • PNHP’s 8-point plan
      • New Study: Perils and Possibilities
      • Emergency COVID-19 Legislation
      • Kitchen Table Toolkit
      • Take Action on COVID-19
      • Telling your COVID-19 story
      • PNHP members in the news
    • Events Calendar
    • Webinars
    • Film Room
    • Join or renew your membership

Health Justice Monitor

Medical Debt Prevalence, Risk Factors, & Effects on Social Determinants of Health

Share on FacebookShare on Twitter

Summary: A representative multi-year survey of US adults found medical debt in 18% of households, with higher risk for those with no insurance, high deductible private insurance, or Medicare Advantage. Medical debt worsened social determinants of health: more food insecurity, inability to pay for housing and utilities, and eviction or foreclosure.


Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US, JAMA Network Open, September 16, 2022, by David Himmelstein, et al.


From the Abstract:

Among 51 872 adults surveyed regarding 2017, 40 784 regarding 2018 and 43 220 regarding 2019, … 10.8% (95% CI, 10.6-11.0) of individuals and approximately 18.1% of households carried medical debt. Persons with low and middle incomes had similar rates; 15.3% (95% CI,14.4-16.2) of uninsured persons had debt, as did 10.5% (95% CI, 10.2-18.8) of the privately-insured. In 2018 the mean medical debt was $21 687/debtor (median $2000 [IQR, $597-$5000]) … hospitalization, disability, and having private high-deductible, Medicare Advantage, or no coverage were risk factors associated with medical indebtedness …

Acquiring medical debt between 2017 and 2019 was a risk factor associated with worsening social determinants of health, with odds ratios (ORs) of 2.20 (95% CI,1.58-3.05) for becoming food insecure; 2.29 (95% CI, 1.73-3.03) for losing ability to pay rent or mortgage; 2.37 (95% CI, 1.75-3.23) for losing ability to pay utilities; and 2.95 (95% CI, 1.38-6.31) for eviction or foreclosure in 2019.


Comment:

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.

A raft of previous studies have established that each year millions of Americans suffer catastrophic financial harm from medical debt, and it’s no surprise that people needing hospitalization, the uninsured, and those with disabilities are at highest risk.  So what’s new here? (Disclosure: we’re study authors)

Two findings stand out.  Individuals with Medicare Advantage coverage are, like the uninsured, at high risk of running up medical debts.  And second, that incurring medical debts causes housing and food insecurity – key social determinants of health.

Health system leaders and policy wonks often point to poor housing and nutrition as root causes of ill health, and they’re right.  But they conveniently avoid noting that the health care system itself is a big contributor to housing problems and food insecurity.  As we note in this article, “Unaffordable medical bills … contribute to a downward spiral of ill-health and financial precarity.”

Practicing medicine in American is akin to bailing a boat as the ship’s owners – i.e. the people who make health policy and run our medical institutions – continually drill holes in the hull.

Our patients desperately need national health insurance.

http://healthjusticemonitor.org…


Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Primary Sidebar

Recent Health Justice Monitor

  • Health Insurance in South Korea
  • Private Equity Endangers Patients
  • Medicare for All Act Reintroduced in Congress
  • US Mortality High & Strongly Linked to Wealth
  • Stand-Up for Simple Health Insurance
  • About PNHP
    • Mission Statement
    • Board of Directors
    • National Office Staff
    • Speakers Bureau
    • Local Chapters
    • Students for a National Health Program
    • Contact Us
    • Privacy Policy
  • About Single Payer
    • What is Single Payer?
      • Policy Details
      • FAQs
      • History of Health Reform
      • Información en Español
    • How do we pay for it?
    • Physicians’ Proposal
      • Full Proposal
      • Supplemental Materials
      • Media Coverage
    • The Medicare for All Act of 2025
  • Take Action
    • Moral Injury and Distress
    • Medical Society Resolutions
    • Recruit Colleagues
    • Schedule a Grand Rounds
    • Letters to the Editor
    • Lobby Visits
    • Organizing in Red Districts
  • Heal Medicare
    • HealMedicare.org
    • Sign our Petition
    • Take our Survey
    • Medicare Disadvantage
    • Stop REACH
  • Kitchen Table Campaign
    • Medicare Disadvantage
    • Maternal Mortality
    • Mental Health Care
    • Health Care Voters Guide
    • COVID-19 Endangers Health Workers
    • COVID-19 Exacerbates Racial Inequities
    • Public Health Emergencies
    • Rural Health Care
    • Racial Health Inequities
    • Surprise Billing
  • Latest News
    • Sign up for e-alerts
    • Medicare Advantage harms report
    • Members in the news
    • Health Justice Monitor
    • Articles of Interest
    • Latest Research
    • For the Press
  • Member Resources
    • 2024 Annual Meeting Materials
    • Newsletter
    • Slideshows
    • Materials & Handouts
    • Kitchen Table Campaign
    • COVID-19 Response
      • Why we Need Medicare for All
      • PNHP’s 8-point plan
      • New Study: Perils and Possibilities
      • Emergency COVID-19 Legislation
      • Kitchen Table Toolkit
      • Take Action on COVID-19
      • Telling your COVID-19 story
      • PNHP members in the news
    • Events Calendar
    • Webinars
    • Film Room
    • Join or renew your membership

Footer

  • About PNHP
    • Mission Statement
    • Board of Directors
    • National Office Staff
    • Speakers Bureau
    • Local Chapters
    • Students for a National Health Program
    • Contact Us
    • Privacy Policy
  • About Single Payer
    • What is Single Payer?
      • Policy Details
      • FAQs
      • History of Health Reform
      • Información en Español
    • How do we pay for it?
    • Physicians’ Proposal
      • Full Proposal
      • Supplemental Materials
      • Media Coverage
    • The Medicare for All Act of 2025
  • Take Action
    • Moral Injury and Distress
    • Medical Society Resolutions
    • Recruit Colleagues
    • Schedule a Grand Rounds
    • Letters to the Editor
    • Lobby Visits
    • Organizing in Red Districts
  • Heal Medicare
    • HealMedicare.org
    • Sign our Petition
    • Take our Survey
    • Medicare Disadvantage
    • Stop REACH
  • Kitchen Table Campaign
    • Medicare Disadvantage
    • Maternal Mortality
    • Mental Health Care
    • Health Care Voters Guide
    • COVID-19 Endangers Health Workers
    • COVID-19 Exacerbates Racial Inequities
    • Public Health Emergencies
    • Rural Health Care
    • Racial Health Inequities
    • Surprise Billing
  • Latest News
    • Sign up for e-alerts
    • Medicare Advantage harms report
    • Members in the news
    • Health Justice Monitor
    • Articles of Interest
    • Latest Research
    • For the Press
  • Member Resources
    • 2024 Annual Meeting Materials
    • Newsletter
    • Slideshows
    • Materials & Handouts
    • Kitchen Table Campaign
    • COVID-19 Response
      • Why we Need Medicare for All
      • PNHP’s 8-point plan
      • New Study: Perils and Possibilities
      • Emergency COVID-19 Legislation
      • Kitchen Table Toolkit
      • Take Action on COVID-19
      • Telling your COVID-19 story
      • PNHP members in the news
    • Events Calendar
    • Webinars
    • Film Room
    • Join or renew your membership
©2025 PNHP