Health and Health Care Utilization Effects of Medical Debt Forgiveness

摘要 美国的医疗保健系统让许多美国人在医疗债务中挣扎。约4400万 个人--有保险的和没有保险的--在集合中有医疗债务， 未偿债务估计为750亿美元。在调查中，患者报告说，医疗债务导致他们延迟或 降低医疗服务利用率。这种利用率的降低可能会对健康产生直接的负面影响， 以及随着年龄增长对健康的长期负面影响。医疗债务也可能有直接的负面影响 通过债务压力和讨债过程对心理健康的影响。最后，医疗债务 最终可能会通过消除储蓄来加剧不良健康事件的财务后果， 影响了退休后的健康和安全过渡。尽管人们普遍关注医疗问题， 债务，几乎没有严格的证据检查医疗债务的健康后果和潜在的 免除医疗债务的好处。这项提议利用了一个已经得到资助、最近开始的 随机对照试验（RCT）的影响，医疗债务免除对家庭财务状况。为此 已经资助，最近开始的研究，我们的非营利合作伙伴RIP医疗债务已同意购买 并免除随机选择的12，000人的债务（总RCT样本量为24，000人， 包括对照组中的个体）。为了这项建议，我们正在寻求资金进行一项调查， 衡量医疗保健利用和医疗债务豁免对我们RCT样本的健康影响。 由于债务废除是随机的，比较治疗和对照受试者的调查结果将 让我们来估计废除医疗债务的因果影响。特别是，我们的调查将衡量 医疗债务对三组结果的影响：（i）医疗保健利用，以医疗保健为衡量标准 就诊、处方药使用和依从性以及未得到满足的医疗需求; ㈡精神健康， 通过有效的抑郁和焦虑筛查来衡量;以及（iii）主观幸福感，通过自我评估来衡量。 报告的健康状况，医疗债务的主观经验，以及放弃的消费。这项研究将是 第一次提供了与美国医疗保健相关的个人债务上升之间的直接因果关系 以及接受者的健康状况。这项研究将寻求确定患者群体， 容易受到医疗债务的负面健康影响，使医疗保健提供者和慈善机构能够针对 减免债务，使自付的保健费用不会最终对人民的健康产生不利影响， 脆弱的病人。

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.