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Citation
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Scott JW, Scott KW, Moniz M, Carlton EF, Tipirneni R, Becker N. JAMA Health Forum 2022; 3(11): e224105. |
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Abstract
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Introduction
One in 5 US households held medical debt in 2021, totaling $88 billion.1 Health shocks, such as traumatic injury, pose significant risk to the health and financial well-being of working-age adults. The degree to which commercially insured patients hospitalized for traumatic injuries experience financial distress remains unknown.
Methods
This cross-sectional study links Blue Cross Blue Shield of Michigan preferred provider organization insurance claims from 2019 through 2021 (exclusive of July-December 2020) to January 2021 Experian consumer credit reports. We identified working-age adults (aged 21-64 years) whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury (between January 2019 and June 2020). We used coarsened exact matching of age, sex, calendar quarter of admission, and zip code social vulnerability index to identify comparison patients admitted between January and December 2021 for traumatic injuries after their January 2021 credit report. Race and ethnicity were not included because the claims database did not reliably collect these data. The University of Michigan institutional review board approved this study, and deemed waived the requirement for informed consent because deidentified data were used. This study followed the STROBE reporting guideline.
Financial outcomes included any delinquent debt, debt in collections (medical and nonmedical), bankruptcy filings in the past 2 years, and credit score. Multivariable logistic and linear regression models incorporated matching weights to compare financial outcomes between the cohorts. A 2-sided P < .05 was considered significant. Analyses were performed using Stata, version 17.0 (StataCorp LLC) software. The eMethods in the Supplement provide additional detail.
Results
The 3165 working-age adults in the postinjury cohort were similar demographically to the 2223 patients in the comparison cohort (Table 1). Relative to the comparison cohort, the postinjury cohort had a 23% higher likelihood of having medical debt in collections (754 [23.8%] vs 429 [19.3%]; P < .001), a 70% higher amount of medical debt in collections (mean [SD], $2087 [$6235] vs $1227 [$1227]; P < .001), and a 110% higher bankruptcy rate (39 [1.2%] vs 13 [0.6%]; P = .03) (Table 2). No significant differences were found regarding credit scores or amount of nonmedical debt in collections.
Discussion
Admission for traumatic injury was associated with higher rates and amounts of medical debt in collections and a doubling of bankruptcy filings among commercially insured working-age adults. No difference was found in credit scores or nonmedical debt in collections. Consistent with previous work,2 we found that for many commercially insured patients, the burden of out-of-pocket (OOP) costs after hospitalization exceeds their ability to pay and could be associated with bankruptcy risk. Another study of commercially insured adults found that the average OOP payments in the year after traumatic injury was $3400 overall and approximately $5000 for patients with high deductibles.3 An association has been noted between financial distress and worse long-term physical and mental health after injury4; strategies to reduce financial distress may improve financial and clinical well-being...
Language: en |