Problems paying medical bills and mental health symptoms post-Affordable Care Act

Wiltshire, Jacqueline; Enard, Kimberly R.; Colato, Edlin Garcia; Orban, Barbara

doi:10.3934/publichealth.2020023

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…While this may be the first study to assess the impact of unmet health care expenses on psychological distress during the pandemic, the impact of health care costs and the inability to pay for medications, treatment, and preventative services on psychological distress and mental health before COVID-19 have been well-documented. 22 , 23 For example, Medicare beneficiaries with a history of depression have been found to experience greater inability to access care, higher unmet social and economic needs, and worse mental health outcomes. 23 …”

Section: Discussionmentioning

confidence: 99%

Financial Hardship and Psychological Distress During the Pandemic: A Nationally Representative Survey of Major Racial-Ethnic Groups in the United States

et al. 2023

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Introduction: While financial hardship has been consistently linked to psychological distress, little research exists on associations between financial hardship experienced during the pandemic and mental health. Methods: We conducted a nationally representative, online survey of American Indian/Alaska Native, Asian, Black/African American, Latino (English and Spanish speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults, 12/2020–2/2021 ( n =5500). Six financial hardship domains were measured (lost income, debt, unmet expenses, unmet health care expenses, housing insecurity, and food insecurity). Psychological distress measures included anxiety-depression symptoms (Patient Health Questionnaire-4), perceived stress (modified Perceived Stress Scale), and loneliness-isolation (“In the past month, how often have you felt lonely and isolated?”). Associations between financial hardship and psychological distress were estimated using multinomial logistic regression. Results: Overall, 70.3% of participants reported experiencing financial hardship (substantial hardship: 21.3%; some hardship: 27.4%; and a little hardship: 21.6%), with Spanish-speaking Latino (87.3%) and Native Hawaiian/Pacific Islander (79.2%) adults being most likely. Debt (57.6%), lost income (44.5%), and unmet expenses (33.7%) were the most common. There was a dose–response association between financial hardship and moderate/severe anxiety-depression symptoms (a little hardship: adjusted odds ratio [aOR]=1.42, 95% confidence interval [CI]=1.12–1.80; some hardship: aOR=3.21, 95% CI=2.58–3.98; and substantial hardship: aOR=8.15, 95% CI=6.45–10.29). Similar dose–response trends were observed with perceived stress and loneliness-isolation. No racial-ethnic difference in the association between financial hardship during the pandemic and psychological distress was seen. Discussion: Financial hardship has had a major impact on psychological distress during the pandemic; moreover, while no racial-ethnic difference in the effect of financial hardship was observed, because racial-ethnic minorities experienced greater hardship, financial hardship may exacerbate psychological distress disparities.

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Section: Discussionmentioning

confidence: 99%

Financial Hardship and Psychological Distress During the Pandemic: A Nationally Representative Survey of Major Racial-Ethnic Groups in the United States

et al. 2023

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“…6 Wiltshire et al showed that among non-elderly adults having problems paying medical bills is associated with an increased likelihood of having one or more days of psychiatric symptoms in the last month. 26 Another study found that medical financial hardship is a predictor of worse physical and mental health among US children. 12 While the detrimental effects of unpaid debt on families' financial welfare are clear, further research on its downstream impact on maternal and child health is needed.…”

Section: Discussionmentioning

confidence: 99%

The Association of Childbirth with Medical Debt in the USA, 2019–2020

Cahn,

Sundaram,

Balachandar

et al. 2023

J GEN INTERN MED

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BACKGROUND: Medical debt affects one in five adults in the USA and may disproportionately burden postpartum women due to pregnancy-related medical costs. OBJECTIVE: To evaluate the association between childbirth and medical debt, and the correlates of medical debt among postpartum women, in the USA. DESIGN: Cross-sectional. PARTICIPANTS: We analyzed female "sample adults" 18-49 years old in the 2019-2020 National Health Interview Survey, a nationally representative household survey. MAIN MEASURES: Our primary exposure was whether the subject gave birth in the past year. We had two family-level debt outcomes: problems paying medical bills and inability to pay medical bills. We examined the association between live birth and medical debt outcomes, unadjusted and adjusted for potential confounders in multivariable logistic regressions. Among postpartum women, we also examined the association between medical debt with maternal asthma, hypertension, and gestational diabetes and several sociodemographic factors. KEY RESULTS: Our sample included n = 12,163 women, n = 645 with a live birth in the past year. Postpartum women were younger, more likely to have Medicaid, and lived in larger families than those not postpartum. 19.8% of postpartum women faced difficulty with medical bills versus 15.1% who were not; in multivariable regression, postpartum women had 48% higher adjusted odds of medical debt problems (95% CI 1.13, 1.92). Results were similar when examining inability to pay medical bills, and similar differences were seen for privately insured women. Among postpartum women, those with lower incomes and with asthma or gestational diabetes, but not hypertension, had significantly higher adjusted odds of medical debt problems. CONCLUSIONS: Postpartum women experience higher levels of medical debt than other women; poorer women and those with common chronic diseases may have an even higher burden. Policies to expand and improve health coverage for this population are needed to improve maternal health and the welfare of young families.

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Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling study

Bershteyn

Richard²,

Zhou³

et al. 2023

The Lancet HIV

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Problems paying medical bills and mental health symptoms post-Affordable Care Act

Cited by 5 publications

References 25 publications

Financial Hardship and Psychological Distress During the Pandemic: A Nationally Representative Survey of Major Racial-Ethnic Groups in the United States

Financial Hardship and Psychological Distress During the Pandemic: A Nationally Representative Survey of Major Racial-Ethnic Groups in the United States

The Association of Childbirth with Medical Debt in the USA, 2019–2020

Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling study

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