Medical Bankruptcy: Still Common Despite the Affordable Care Act

Himmelstein, David U.; Lawless, Robert M.; Thorne, Deborah; Foohey, Pamela; Woolhandler, Steffie

doi:10.2105/ajph.2018.304901

Cited by 134 publications

(96 citation statements)

References 3 publications

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“…Many families in the United States face difficulty in paying their medical bills [1]. Approximately two out of three bankruptcies in the United States are related to health care, and more than 530,000 families every year file bankruptcy because of inability to pay medical bills [2,3].…”

Section: Introductionmentioning

confidence: 99%

Price Transparency in Radiology—A Model for the Future

Anzai

Delis

Pendleton

2020

Journal of the American College of Radiology

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Medicine is the only business transaction in which consumers make important purchase decisions without knowing how much they have to pay. Lack of price transparency in health care imposes financial burden and anxiety among patients as the cost of health care has been shifting from employers to patients through high-deductible health plans (HDHPs). Health economists and policymakers anticipated that HDHPs with price transparency would be a catalyst for patients to "shop" for low-price providers, thus reducing overall health care spending. For patients to shop health care services, price transparency is a requisite. The Department of Health and Human Services mandate of publicly disclosing the hospital chargemaster and state legislatures demanding greater health care price transparency are just two examples of external forces challenging the long history of price opacity in health care. Imaging, pharmacy, laboratory tests, and ambulatory surgeries are considered potentially shoppable health care services. This article examines the intended motivation of price transparency, the limitations of current price transparency tools, and what impact price transparency may have on radiology. We share our experience in developing and implementing University of Utah's online interactive price transparency tool to estimate patients' outof-pocket expenses.

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Section: Introductionmentioning

confidence: 99%

Price Transparency in Radiology—A Model for the Future

Anzai

Delis

Pendleton

2020

Journal of the American College of Radiology

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“…This is clearly supported by the fact that medical bankruptcies have not improved since the initiation of the Affordable Care Act. 7 A cancer diagnosis can be financially devastating for families, 8 particularly because the cost of newer therapeutics has skyrocketed. Financial toxicity affects outcomes because financial burdens may lead to physical and psychological distress 9,10 or cause victims to skip doses of medicine, reduce follow-up, or even cut back on basic living expenses.…”

Section: Improving Access To Cancer Clinical Trials By Reducing the Fmentioning

confidence: 99%

“…Despite recent policy changes designed to improve access to health care, it is essential to realize that an insurance card alone does not ensure access. This is clearly supported by the fact that medical bankruptcies have not improved since the initiation of the Affordable Care Act …”

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confidence: 98%

Improving access to cancer clinical trials by reducing the financial burden

Winkfield

2019

Cancer

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“…were the result of medical illness or medical debt (14). The impact can be particularly severe for black patients, who frequently develop sarcoidosis approximately 10 years earlier than white patients (15) and potentially lose out on income and building wealth when the disease strikes during prime working years (16).…”

mentioning

confidence: 99%

“…However, 46% of those in the middle stratum of SES ($35,000-85,000) reported that their finances were "greatly or severely affected," and 28% reported job loss due to the illness. An analysis of national bankruptcy data by Himmelstein and colleagues (17) showed that over 75% of medical debtors were ensured, demonstrating a major limitation of employer-based health coverage when prolonged illness leads to disability or job loss (14).…”

mentioning

confidence: 99%

Sarcoidosis: An Ill-afforded Disease

Cozier

Govender

2020

Am J Respir Crit Care Med

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Sarcoidosis is a systemic inflammatory disorder of unknown origin. Its clinical course ranges from asymptomatic disease with spontaneous remission to chronic illness resulting in significant organ impairment and even death (1). Socioeconomic status (SES) refers broadly to the "standing or class of an individual or group," typically measured singularly or as a composite of income, educational level, occupational class, wealth, and race (2). Throughout history, SES has been linked to differences in morbidity and mortality for nearly every known illness, with those of greater means generally enjoying better overall health than those in lower strata (3). With few exceptions, SES has been associated with sarcoidosis risk. In the ACCESS (A Case Control Etiologic Study of Sarcoidosis) study, black race and low income were each associated with greater disease severity at presentation (4). Mining, construction, and agricultural occupations have been associated with up to fourfold increases in sarcoidosis risk (5, 6), and increased risk of sarcoidosis and "sarcoid-like" disease have been described in firefighters and 9/11 firstresponders (7). What is less clear are the mechanisms by which sarcoidosis effects SES. Previous studies have found that subjects with sarcoidosis experienced more illness-related sick days annually than those without sarcoidosis (8) and that sarcoidosis-related disability persisted for more than 5 years after diagnosis (9). In this issue of the Journal, Harper and colleagues (pp. 955-964) further evaluate the relationship between household income and disease trajectory in a registry-based cohort of cases enrolled in the Foundation for Sarcoidosis Research-Sarcoidosis Advanced Registry for Cures (FSR_SARC) database (10, 11). Among their findings, they report that low-SES patients-defined as self-reported household income of ,$35,000-had greatest negative impact on their financial status, and worse long-term outcomes, including steroid-associated illness. Multiple factors mediate the effect of sarcoidosis on SES. An analysis of the Optum Healthcare database estimated the average individual cost of care for sarcoidosis to be in excess of $32,000 annually, with the top 5% of patients incurring costs exceeding $93,000 (12). Previous studies show that patients with "high-cost" sarcoidosis are more likely to receive care in the emergency department, be on prednisone (8), and experience more severe disease (13). These costs disproportionately affect patients with lower income, and economic recovery can be difficult because of sizable medical debt. In the years after the passage of the Affordable Care Act, approximately 67% of all bankruptcies

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Medical Bankruptcy: Still Common Despite the Affordable Care Act

Cited by 134 publications

References 3 publications

Price Transparency in Radiology—A Model for the Future

Price Transparency in Radiology—A Model for the Future

Improving access to cancer clinical trials by reducing the financial burden

Sarcoidosis: An Ill-afforded Disease

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