Health and Health Care Utilization Effects of Medical Debt Forgiveness

摘要 美国的医疗保健体系让许多美国人为医疗债务而苦苦挣扎。大约4400万 个人--包括参保和未参保的个人--有代收的医疗债务，以及总的医疗债务 未偿还债务估计为750亿美元。在调查中，患者报告说，医疗债务导致他们延迟或 降低医疗保健利用率。这种使用率的减少可能会立即产生负面的健康影响，因为 以及随着个人年龄的增长，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 通过债务压力和收债过程对心理健康的影响。最后，医疗债务 最终可能会抹去储蓄，从而加剧不利健康事件的财务后果 破坏了向退休的健康和安全过渡。尽管人们普遍担心医疗保健 债务，几乎没有严格的证据来检验医疗债务的健康后果和潜在的 医疗债务减免的好处。这项建议利用了已经获得资金的、最近开始的 关于医疗债务减免对家庭财务影响的随机对照试验。为了这个 我们的非营利性合作伙伴RIP医疗债务已经同意购买 并免除随机选择的12,000名个人的债务(对于24,000名个人的总RCT样本量， 包括控制组中的个人)。对于这项建议，我们正在寻求资金进行一项调查， 在我们的随机对照试验样本上，测量医疗债务减免的医疗保健利用和健康影响。 因为债务免除是随机的，所以比较治疗和对照受试者的调查结果将 允许我们估计取消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：(1)医疗保健利用率，以医疗保健衡量 就诊、处方药的使用和依从性以及未得到满足的医疗需求；(2)精神健康，如 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- 报告的健康，主观经历与医疗债务，放弃消费。这项研究将是 首先提供了与美国医疗保健相关的不断上升的个人债务之间的直接、因果联系 以及接受者的健康结果。这项研究将寻求确定特别是 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 减免债务，使自付的医疗费用最终不会对健康产生不利影响 易受伤害的病人。

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.