Massachusetts' recent health reform has decreased the number of uninsured, but no study has examined medical bankruptcy rates before and after the reform was implemented.
In 2009, we surveyed 199 Massachusetts bankruptcy filers regarding medical antecedents of their financial collapse using the same questions as in a 2007 survey of 2314 debtors nationwide, including 44 in Massachusetts. We designated bankruptcies as "medical" based on debtors' stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.
In 2009, illness and medical bills contributed to 52.9% of Massachusetts bankruptcies, versus 59.3% of the bankruptcies in the state in 2007 (P=.44) and 62.1% nationally in 2007 (P<.02). Between 2007 and 2009, total bankruptcy filings in Massachusetts increased 51%, an increase that was somewhat less than the national norm. (The Massachusetts increase was lower than in 54 of the 93 other bankruptcy districts.) Overall, the total number of medical bankruptcies in Massachusetts increased by more than one third during that period. In 2009, 89% of debtors and all their dependents had health insurance at the time of filing, whereas one quarter of bankrupt families had experienced a recent lapse in coverage.
Massachusetts' health reform has not decreased the number of medical bankruptcies, although the medical bankruptcy rate in the state was lower than the national rate both before and after the reform.
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"Medical debt, defined as personal debt incurred from health care costs and expenses, limits access to care and timely use of health care services123, which contributes to avoidable emergency room use, hospitalizations, and poor health out- comes [4, 5] . Medical debt is also associated with severe financial hardships and is one of the leading causes of personal bankruptcy [2, 6]. Rising health care costs, the steady decline in employer-sponsored health insurance benefits, and stagnant incomes have contributed to the increasing rate of medical debt and problems paying medical bills [1, 7]. "
[Show abstract][Hide abstract]ABSTRACT: Objectives:
Although the proportion of people reporting problems paying medical bills has declined in the aftermath of the Great Recession, it is unclear if this decline has been caused by self-rationing of care, particularly among disadvantaged groups. We examined African American-White differences in problems paying medical bills prevalence along with factors which may account for observed differences.
We used cross-sectional data from 2007 (N = 13,064) and 2010 (N = 11,873) waves of the nationally representative, Health Tracking Household Survey. Logistic regression analyses, accounting for complex survey design and weights, were performed to compute population-based estimates.
Overall, the prevalence of problems paying medical bills was 18.3 % in 2007 and 19.8 % in 2010. African Americans more frequently reported having problems paying medical bills than Whites. Among African Americans, problems paying medical bills decreased from 30 % in 2007 to 25 % in 2010, which was largely explained by fewer problems reported by those in poor/fair health. Problems paying medical bills significantly declined from 44 % in 2007 to 33 % in 2010 for African Americans in poor/fair health, but remained almost constant for those in good health and very good/excellent health.
Our findings suggest that African Americans in poor health may be rationing or forgoing necessary care as a result of the recession, which could increase existing health disparities and future health spending. Efforts to reduce racial/ethnic disparities may depend on the extent to which the lingering effects of the Great Recession are mitigated.
[Show abstract][Hide abstract]ABSTRACT: One of the most fundamental characteristics of a liberal order is that both the state and the law follow the principle of personal responsibility and assign to the citizens the responsibility for the consequences of their voluntary decisions. But to rely primarily on the principle of personal responsibility in the health care system holds the danger of attributing the cause of their health problems to the already disadvantaged (“blaming the victim”) and of releasing the welfare state from its responsibility to foster social structures that support health-conscious decisions.
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No preview · Article · Jan 2012 · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen