Health and Health Care Utilization Effects of Medical Debt Forgiveness

医疗债务减免对健康和医疗保健利用的影响

基本信息

批准号：
10392857
负责人：
Wesley Yin
金额：
$ 60.99万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-15 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10392857
关键词：
Adoption Affect Age American Anxiety Caring Censuses Charities Clinical Coinsurance Collection Consumption Control Groups Correlative Study Data Deductibles Depression screen Drug Prescriptions Drug Utilization Elderly Emergency department visit Equilibrium Event Family Foundations Funding Goals Health Health Care Costs Health Care Surveys Health Personnel Healthcare Healthcare Systems Hospitalization Household Individual Literature Measures Medical Mental Depression Mental Health Outcome Outcome Measure Patient Self-Report Patients Personal Satisfaction Process Randomized Randomized Controlled Trials Reporting Retirement Running Sample Size Sampling Savings Secure Stress Surveys Testing Treatment outcome Uncertainty Uninsured Visit Vulnerable Populations Well in self adverse outcome base experience forgiveness health care service utilization health plan improved medication compliance physical conditioning self esteem social stigma treatment group

项目摘要

ABSTRACT The U.S. health care system leaves many Americans struggling with medical debt. Approximately 44 million individuals – both insured and uninsured – have medical debt in collections, and aggregate medical debt outstanding is estimated at $75 billion. In surveys, patients report that medical debt leads them to delay or reduce health care utilization. This reduction in utilization may produce immediate negative health effects as well as longer-run negative health effects as individuals age. Medical debt may also have direct negative impacts on mental health through the stress of debt and the debt collections process. Finally, medical debt may compound the financial consequences of adverse health events by wiping out savings, ultimately undermining a healthy and secure transition to retirement. Despite the widespread concern about medical debt, there is little rigorous evidence examining the health consequences of medical debt and the potential benefits of medical debt forgiveness. This proposal leverages an already-funded, recently-commenced randomized control trial (RCT) on the effects of medical debt forgiveness on household finances. For this already-funded, recently-commenced study, our non-profit partner RIP Medical Debt has agreed to purchase and forgive debt for a randomly selected 12,000 individuals (for a total RCT sample size of 24,000 individuals, including individuals in the control group). For this proposal, we are seeking funding to conduct a survey that measures the health care utilization and health effects of medical debt forgiveness on our RCT sample. Because debt abolishment is randomized, comparing surveyed outcomes of treatment and control subjects will allow us to estimate the causal impact of medical debt abolishment. In particular, our survey will measure the effects of medical debt on three sets of outcomes: (i) health care utilization, as measured by medical care visits, prescription drug utilization and adherence, and unmet need for medical care; (ii) mental health, as measured by validated screens for depression and anxiety; and (iii) subjective wellbeing, as measured by self- reported health, subjective experience with medical debt, and forgone consumption. This study would be the first to provide a direct, causal connection between the rising personal debt associated with U.S. health care and the health outcomes of its recipients. And the study will seek to identify patient groups that are particularly vulnerable to negative health impacts of medical debt, allowing health care providers and charities to target debt relief so that the out-of-pocket costs for health care do not end up adversely affecting the health of vulnerable patients.

抽象的美国医疗保健系统让许多美国人陷入约 4400 万医疗债务的困境。个人（无论是投保还是未投保）都有医疗债务在催收，以及总医疗债务调查显示，未偿还的医疗债务估计为 750 亿美元。减少医疗保健利用率。这种利用率的降低可能会产生直接的负面健康影响，如随着个人年龄的增长，医疗债务也可能产生直接的负面影响。债务压力和收债过程对心理健康的影响最后是医疗债务。最终可能会耗尽储蓄，从而加剧不良健康事件的财务后果尽管人们普遍担心医疗问题，但仍会破坏健康、安全的退休过渡。债务，几乎没有严格的证据来检验医疗债务对健康的影响以及潜在的影响该提案利用了最近开始的一项已经资助的项目。关于医疗债务减免对家庭财务影响的随机对照试验（RCT）。已经资助的、最近推荐的研究，我们的非营利合作伙伴 RIP Medical Debt 已同意购买并免除随机选择的 12,000 人的债务（RCT 样本总数为 24,000 人，包括对照组中的个人）对于这项提案，我们正在寻求资金来进行一项调查：在我们的随机对照试验样本中衡量医疗保健利用率和医疗债务减免对健康的影响。由于债务废除是随机的，因此比较治疗对象和对照对象的调查结果将使我们能够估计废除医疗债务的因果影响。特别是，我们的调查将衡量医疗债务废除的因果影响。医疗债务对三组结果的影响：(i) 医疗保健利用，以医疗保健衡量就诊、处方药使用和依从性以及未满足的医疗保健需求；通过经过验证的抑郁和焦虑筛查来测量；以及（iii）主观幸福感，通过自我测量来测量。报告的健康状况、医疗债务的主观经历以及放弃的消费将是这项研究的重点。首先提供与美国医疗保健相关的个人债务不断增加之间的直接因果关系以及其接受者的健康结果，该研究将寻求确定特别重要的患者群体。容易受到医疗债务的负面健康影响，从而使医疗保健提供者和慈善机构能够瞄准债务减免，以便自付费用不会最终对人们的健康产生不利影响弱势患者。