High levels of medical debt are linked to declining physical and mental health — and can even contribute to premature death, according to a new study by the American Cancer Society.
The report, published this week in the Journal of the American Medical Association Network Open, examined 2018 medical debt data from the Urban Institute’s Debt in America project.
That data was compared to self-reported health statuses and premature death rates in nearly 3,000 counties nationwide — or 93% of the country, including Nassau and Suffolk — compiled by County Health Rankings & Roadmaps, along with 2015-19 mortality data from the National Vital Statistics System. Premature death was measured as years of life lost before the age of 75.
Researchers found that when 1% more of the general population has medical debt, the result is 18.3 more unhealthy physical days; 17.9 more mentally unhealthy days and 1.12 years of life lost per 1,000 people during the past month.
Medical debt and elevated mortality rates were consistently linked, researchers found, for all leading causes of death in the United States including cancer, heart disease and suicide.
“Patients are increasingly burdened by high out-of-pocket costs for health care in the U.S. including problems paying medical bills and medical debt, but little was known about county-level associations of medical debt with population health,” said Xuesong Han, lead author of the study and scientific director of health services research at the American Cancer Society. “Our findings reinforce medical debt as an important social determinant of health, which, unfortunately, may threaten public health in the country.”
Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, a Manhattan nonprofit that assists patients with medical bills, said it’s not uncommon for individuals who owe thousands to hospitals to cease medical treatment because of their mounting debt.
“We see that patients who have medical debt or owe money to a hospital are scared to go back for care because they’re so afraid of incurring more medical bills,” said Benjamin, adding that the stress of the bills can also aggravate underlining medical conditions. “Especially for people with cancer, they don’t want their families to inherit this debt. And sometimes people just say, ‘OK, I’m not going to go back. I’m not going to continue care.’”
The first-of-its-kind study did not show a direct cause-and-effect between medical debt and early death, but found a strong association between individuals facing financial hardships and declining health outcomes.
Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said the study “reiterates how the rising cost of health care in the U.S. continues to take a significant toll on patients and their families. With a system that continues to be unaffordable for too many touched by cancer, addressing medical debt is a growing public policy priority among cancer patients and survivors.”
On average, 19.8% of the U.S. population had medical debt in collections, with the highest levels concentrated in Texas, Louisiana, Georgia, Tennessee, South Carolina, North Carolina and West Virginia, research shows.
The figures are considerably better on Long Island, where 3.54% of Nassau residents and 4.69% of Suffolk residents had medical debt, the data shows. Statewide, 6% of New Yorkers have medical debt in collection.
Among the most vulnerable to medical debt, experts said, are racial minorities, younger individuals, people living in poverty and with low levels of education, those with chronic conditions, the uninsured and individuals with high-deductible insurance plans.
“The simple fact of having medical debt can undermine someone’s health care,” said Allison Sesso, president and chief executive of RIP Medical Debt, a Queens-based nonprofit that uses donations to buy large amounts of medical debt at a steep discount. “We welcome this study … as an opportunity to reinforce the important national conversation about medical debt and health care costs in this country.”
Last year, Gov. Kathy Hochul signed legislation preventing unpaid medical debt from appearing on the credit reports of New Yorkers.