Medical costs create hardships for more than half of Americans

By | May 3, 2019

Medical financial hardship is very common among people in the United States, with more than half reporting problems with affordability, stress, or delaying care because of cost, finds a study by the American Cancer Society.

Appearing early online in the Journal of General Internal Medicine, the study estimates more than 100 million people in the US. experience medical financial hardship.

Previous studies have looked at the financial toll of a cancer diagnosis, but less is known about financial hardship in the general population, outside of oncology. Here, researchers assessed the prevalence of material, psychological and behavioral domains of financial hardship using data from the 2015-2017 National Health Interview Survey.


High out-of-pocket spending for medical care can lead to a depletion of assets and medical debt, as well as distress and worry about household finances. Patients may delay or forgo needed medical care because of cost, jeopardizing benefits of treatment. Illness can also impact the ability to work and reduce productivity, limiting household income, and potentially reducing access to employer-sponsored health insurance in the working age population ages 18-64.

Overall, 56 percent of adults reported at least one domain of medical financial hardship, representing 137.1 million adults in the US. Compared with those 65 years and older, adults 18 to 64 reported higher material (28.9 vs. 15.3 percent), psychological (46.9 vs. 28.4 percent) and behavioral (21.2 vs. 12.7 percent) medical financial hardship.

Among adults 18 to 64, those with less educational attainment and more health conditions were more likely to report great intensity of hardship. Women were more likely to report multiple domains of hardship than men. And the uninsured were more likely to report multiple domains of hardship (52.8 percent), compared to those with some public (26.5 percent) and private insurance (23.2 percent).

The authors say unless action is taken, the problem is likely to worsen. “With increasing prevalence of multiple chronic conditions, higher patient cost-sharing, and higher costs of healthcare, the risk of hardship will likely increase in the future,” they wrote. “Thus, development and evaluation of the comparative effectiveness and cost-effectiveness of strategies to minimize medical financial hardship will be important.”


Reducing costs has long been a goal of the healthcare industry. Health system execs hope that reducing care variations will help to bend the cost curve, and many say that sustainable cost control is one of their top priorities.

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