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Medical debt keeps people away from care

A survey reveals the financial reality of a frayed safety-net system that fails to serve many uninsured Americans.

By Joel B. Finkelstein, amednews staff. Feb. 3, 2003.

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Washington -- Uninsured and ill, many Americans face barriers to medical care because of past bills, according to a new survey by the Access Project, a Boston-based health care think tank.

"Our findings challenge the myth that Americans without health insurance receive free care," said Mark Rukavina, executive director of the project, a program of Brandeis University in Waltham, Mass.

The survey found that 46% of uninsured patients had debts from previous medical care, and 24% of the patients said it had deterred them from seeking follow-up care. Thirteen percent also reported not being able to afford any or all of their prescribed medication.

The financial stress of medical problems is also reflected in research on bankruptcy trends.

"About half of the families who file for bankruptcy do so in the aftermath of serious medical problems," said Harvard University law professor Elizabeth Warren.

That amounts to 750,000 families a year, and the number is growing every year.

People bankrupted by medical problems run the gamut, she said. Some lose their jobs and then get sick; others get sick and are fired. Some experience a traumatic illness or injury that wipes them out financially, and others have a chronic illness that slowly drains their resources.

The Access Project survey found that uninsured patients were often hounded for payment, turned over to collection agencies and/or forced into bankruptcy by medical debt.

"People without health insurance too often trade medical problems for financial problems," Rukavina said.

Safety-net expansion is not enough

Community medical clinics, the backbone of the safety net, do a great job of serving their populations by providing preventive and primary care to all comers, said Dan Hawkins, vice president of the National Assn. of Community Health Centers.

"But securing other needed services for our uninsured patients, like specialty and inpatient care or prescribed drugs and diagnostic tests, has proven increasingly difficult, and, in too many cases, all but impossible," he said.

President Bush has proposed doubling the capacity of the country's community health network as one part of his strategy to improve care for the uninsured.

"While building more health centers over the next five years will certainly do much to open the doors of health care to more of the uninsured, it alone will not solve the health care crisis we face today," Hawkins said.

Recent research has shown a drop in charity care among physicians, which Hawkins said places even more financial pressures on the safety-net facilities.

Rural health centers may have an even more difficult time making ends meet, said Michael Beachler, director of the Rural Health Policy Center at the Pennsylvania State University College of Medicine, Hershey, Pa.

Many of the survey's results were more pronounced at rural facilities, especially community clinics.

"Rural hospitals don't get paid as well as urban facilities for the same cases," Beachler said. These facilities depend heavily on federal funds, despite lower Medicare reimbursement, he added.

Several Republican senators from rural states are pushing for legislation to equalize Medicare payments across the country.

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 ADDITIONAL INFORMATION: 

                     Urban/
                    suburban  Rural
Emergency department    63%    68%
Hospital outpatient
  department            40%    36%
Sliding-scale
  health center         23%    48%