Medical Debt in the US, 2009-2020
Medical Debt in the US, 2009-2020
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DOI：
10.1001/jama.2021.8694
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发表时间：
2021-07-20
影响因子：
120.7
通讯作者：
Yin, Wesley
中科院分区：
文献类型：
--
作者：
Kluender, Raymond;Mahoney, Neale;Yin, Wesley
问题美国催收的医疗债务总额和分布情况如何？在这项对全国代表性的10%个人小组的信用报告进行的回顾性分析中，估计美国17. 8%的个人在2020年6月有医疗债务（反映了在COVID-19大流行之前提供的护理）。医疗债务在生活在南方和邮政编码最低收入阶层的个人中最高，并且更加集中在没有扩大医疗补助的州的低收入社区。这项研究根据2009年1月至2020年6月的消费者信用报告，对美国的医疗债务总额进行了估计，反映了在COVID-19大流行之前提供的医疗服务，并表明生活在南方和低收入社区的个人的医疗债务总额最高，重要性医疗债务在美国日益受到关注，但人们对医疗债务的数量和分布及其与医疗保健政策的关系了解有限。目的测量全国和地理区域和收入群体的医疗债务金额及其与《平价医疗法案》下医疗补助扩张的相关性。设计、设定及参与者有关医疗债务催收的数据来自2009年1月至2020年6月期间具有全国代表性的10%消费者信贷报告小组（反映COVID-19大流行之前提供的护理）。收入数据来自2014-2018年美国社区调查。该样本由41亿人月观察（近4000万个独立个体）组成。这些数据用于估计医疗债务金额（全国范围内以及按地理区域和邮政编码收入十分位数），并检查医疗补助扩张与医疗债务之间的关联（总体和按收入群体）。暴露地理区域（美国人口普查区域）、收入组（邮政编码收入十分位数）和州医疗补助扩展状态。主要成果和措施债务催收员可以催收的医疗债务的存量（信用报告中列出的所有未偿债务）和流量（前12个月信用报告中列出的新债务）。结果在2020年6月，估计有17.8%的个人有医疗债务（13.0%在上一年累计债务），平均金额为429美元（311美元在上一年累计）。医疗债务的平均存量在南部最高，在东北部最低（616美元对167美元;差异，448美元[95% CI，435 - 462美元]），穷人比富人高邮政编码收入十分位数（677美元对126美元;差异，551美元[95% CI，520 - 581美元]）。在2013年至2020年期间，2014年扩大医疗补助的州的医疗债务平均流量下降了34.0个百分点（95% CI，18.5-49.4个百分点）（从330美元到175美元），比没有扩大医疗补助的州（从613美元到550美元）。在扩张州，最低和最高邮政编码收入十分位数之间的医疗债务平均流量的差距减少了145美元（95% CI，95 - 194美元），而在非扩张州，差距增加了218美元（95% CI，163 - 273美元）。结论及相关性本研究根据2009年1月至2020年6月的消费者信贷报告，估计美国的医疗债务总额，反映COVID-19大流行之前提供的护理，并表明生活在南方和低收入社区的个人的医疗债务总额最高。然而，需要进一步研究与COVID-19相关的债务。这项对全国代表性的10%个人小组的信用报告进行的回顾性队列分析估计了全国和地理区域以及收入群体的医疗债务金额，以及其与《平价医疗法案》下医疗补助扩张的关联。
Question What is the total amount and distribution of medical debt in collections in the US? Findings In this retrospective analysis of credit reports for a nationally representative 10% panel of individuals, an estimated 17.8% of individuals in the US had medical debt in collections in June 2020 (reflecting care provided prior to the COVID-19 pandemic). Medical debt was highest among individuals who lived in the South and in zip codes in the lowest income deciles and became more concentrated in lower-income communities in states that did not expand Medicaid. Meaning This study provides an estimate of the amount of medical debt in collections in the US based on consumer credit reports from January 2009 to June 2020, reflecting care delivered prior to the COVID-19 pandemic, and suggests that the amount of medical debt was highest among individuals living in the South and in lower-income communities, although further study is needed regarding debt related to COVID-19.Importance Medical debt is an increasing concern in the US, yet there is limited understanding of the amount and distribution of medical debt, and its association with health care policies. Objective To measure the amount of medical debt nationally and by geographic region and income group and its association with Medicaid expansion under the Affordable Care Act. Design, Setting, and Participants Data on medical debt in collections were obtained from a nationally representative 10% panel of consumer credit reports between January 2009 and June 2020 (reflecting care provided prior to the COVID-19 pandemic). Income data were obtained from the 2014-2018 American Community Survey. The sample consisted of 4.1 billion person-month observations (nearly 40 million unique individuals). These data were used to estimate the amount of medical debt (nationally and by geographic region and zip code income decile) and to examine the association between Medicaid expansion and medical debt (overall and by income group). Exposures Geographic region (US Census region), income group (zip code income decile), and state Medicaid expansion status. Main Outcomes and Measures The stock (all unpaid debt listed on credit reports) and flow (new debt listed on credit reports during the preceding 12 months) of medical debt in collections that can be collected on by debt collectors. Results In June 2020, an estimated 17.8% of individuals had medical debt (13.0% accrued debt during the prior year), and the mean amount was $429 ($311 accrued during the prior year). The mean stock of medical debt was highest in the South and lowest in the Northeast ($616 vs $167; difference, $448 [95% CI, $435-$462]) and higher in poor than in rich zip code income deciles ($677 vs $126; difference, $551 [95% CI, $520-$581]). Between 2013 and 2020, the states that expanded Medicaid in 2014 experienced a decline in the mean flow of medical debt that was 34.0 percentage points (95% CI, 18.5-49.4 percentage points) greater (from $330 to $175) than the states that did not expand Medicaid (from $613 to $550). In the expansion states, the gap in the mean flow of medical debt between the lowest and highest zip code income deciles decreased by $145 (95% CI, $95-$194) while the gap increased by $218 (95% CI, $163-$273) in the nonexpansion states. Conclusions and Relevance This study provides an estimate of the amount of medical debt in collections in the US based on consumer credit reports from January 2009 to June 2020, reflecting care delivered prior to the COVID-19 pandemic, and suggests that the amount of medical debt was highest among individuals living in the South and in lower-income communities. However, further study is needed regarding debt related to COVID-19.This retrospective cohort analysis of credit reports for a nationally representative 10% panel of individuals estimates the amount of medical debt nationally and by geographic region and income group and its association with Medicaid expansion under the Affordable Care Act.