Study Finds Medical Debt Can Result in Significant Adverse Effects on Physical, Mental Health

Communication plays a critical role in coping strategies around health and financial challenges, according to a recent qualitative study that investigated how people cope with these challenges.

"This is one of the first studies to look at how people respond to the combination of financial uncertainties and health uncertainties," said study first author Lynsey Romo, an associate professor of communication at North Carolina State University, in a press release. "It drives home that uncertainty about money and uncertainty about health go hand in hand. Financial limitations created significant health challenges—such as an inability to afford prescription medications. And health problems created significant expenses leading to serious financial challenges.”

Romo added that the study found that these challenges can span income levels and are not only present in the lives of lower-income households.

“You can have a good job, good insurance, do everything 'right' and still find yourself struggling due to the nature of the health care system in the US," Romo said in the press release.

During the study, the investigators conducted interviews with 17 US adults. Of the 17, all were white and 14 identified as women. Each of the study participants had medical debt, which ranged from less than $10,000 to more than $150,000. The salaries of the participants also ranged from less than $10,000 to more than $150,000. For the patients, the health problems that caused the financial difficulties included cancer, cystic fibrosis, and stroke.

The investigators observed that health-related financial uncertainty resulted in significant adverse effects on the physical and mental health of many of the study participants. For example, several reported symptoms of emergent depression and other mental health issues that were connected with their health conditions and related financial problems.

During the study, one participants explained, “It gets to the point where [the financial uncertainty] just weighs against you. Like, am I worth doing this procedure?...I'll never make this much money. I'm never going to be able to pay this off.”

The investigators observed that there were a range of strategies that participants used to manage uncertainty in the face of these challenges.

"Many of these strategies revolved around communication," Romo said in the press release. "Seeking information and emotional support from your social network is inherently about communication. Seeking financial help or help in getting to medical appointments is about communication. Advocating for yourself or others in the context of medical care is all about communication. So being able to share information effectively is incredibly important."

Other strategies were also used by participants when managing uncertainty, such as the decision to make sacrifices. However, some of these sacrifices had their own health consequences as well.

For example, study participants reported strategies such as buying less food in order to be able to pay for medication; not being able to afford medications at all; taking less medication than a doctor prescribed in order to make it last longer; and not being able to attend health appointments due to the associated cost.

"Qualitative studies, like this one, are important," Romo said in the press release. "There are lots of statistics about how many people are struggling with medical debt. I remember seeing survey data from early last year showing that more than 30% of US workers carry medical debt—and that was looking at people with jobs, before the pandemic.”

Romo explained that for this reason, qualitative studies are beneficial as they provide a clearer view of what those numbers mean in real-world terms.

"What effect does this combination of financial and health uncertainty have on people? And how do they deal with it? Our study suggests that the effect is profound,” Romo said in the press release. “The pandemic and related expenses may make it worse. And this is something we need to be looking at."

REFERENCE

Study sheds light on how people cope with health challenges and medical debt. North Carolina State University; February 16, 2021. https://sciencesources.eurekalert.org/pub_releases/2021-02/ncsu-ssl021621.php. Accessed February 17, 2021.