The Joint Distribution Of High Out-Of-Pocket Burdens, Medical Debt, And Financial Barriers To Needed Care

Health Aff (Millwood). 2023 Nov;42(11):1517-1526. doi: 10.1377/hlthaff.2023.00604.


Health care financial pressures in the US can manifest themselves in a variety of ways. Some families face high out-of-pocket spending on insurance premiums and medical care relative to income and assets. Some face medical debt that must be paid off over time. And some face delays or go without needed care for reasons involving cost. Whereas prior research has generally focused on these problems separately, a more complete picture of the challenges facing US families can be obtained by examining the joint distribution of these three financial problems. Applying relatively strict definitions of financial problems to data from the 2018-19 Medical Expenditure Panel Survey, we found that 27.0 percent of nonsenior adults lived in families with at least one of the three financial strains assessed. The share of participants facing more broadly defined financial problems was 45.4 percent. Prevalence varied across sociodemographic characteristics, families' health care needs, insurance coverage, and financial resources. The wide distribution of financial strain provides context for ongoing reforms in billing, coverage, and medical debt, as well as for the urgency felt across the country for health care financing reform.

MeSH terms

  • Adult
  • Cost of Illness*
  • Delivery of Health Care
  • Health Expenditures
  • Humans
  • Income
  • Insurance, Health*
  • United States