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Many Americans report struggling with the prohibitive cost of healthcare.
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  • Interviews with people dealing simultaneously with illness and medical debt reveal a painful, vicious cycle.
  • The combination of health issues and medical debt leads to an unhealthy level of uncertainty for many.
  • Financial uncertainty may critically undermine a person’s health recovery.

Many people struggle with the high cost of healthcare in the United States. A September study found, for example, that 56% of American adults have had unpaid medical bills sent to collection.

Dealing with financial problems is never easy, but when those problems are related to healthcare, circumstances can quickly progress from difficult to dire.

To understand the often-spiraling interplay between health and financial issues better, researchers from North Carolina State University in Raleigh, NC — in collaboration with colleagues from other academic institutions — conducted extensive interviews with a small group of Americans across a range of income levels. Their study appears in the journal Health Communication.

The study’s first author, Dr. Lynsey Romo, says, “[y]ou can have a good job, good insurance, do everything ‘right’ and still find yourself struggling due to the nature of the healthcare system in the U.S.”

While there is ample statistical evidence that many people in the U.S. struggle with medical debt and health issues, a qualitative study, such as this one, can provide a deeper appreciation of the problem.

According to Dr. Romo: “Qualitative studies give us a fuller understanding of what those numbers mean in real-world terms. What effect does this combination of financial and health uncertainty have on people? And how do they deal with it?”

Dr. Romo and her colleagues spoke in-depth with 17 white Americans from 11 states in the summer and fall of 2018, so the study does not address the effects of the COVID-19 pandemic. All but three of the individuals identified themselves as women.

Participants were between 20–62 years of age and represented a wide range of education levels, from high school or General Educational Development to doctoral degrees. In regard to marital status, nine individuals had never been married, two were married, five were separated or divorced, and one was widowed.

Medical debt among interviewees ranged from less than $10,000 to more than $150,000.

These debts arose from a variety of health challenges, including cancer, stroke, brain tumors, dental issues, mental health services, blood clots, cystic fibrosis, and gender transition-related care.

Dr. Romo notes that the story the interviewees told “drives home that uncertainty about money and uncertainty about health go hand in hand.”

“Financial limitations created significant health challenges — such as an inability to afford prescription medications. And health problems created significant expenses leading to serious financial challenges.”

– Dr. Lynsey Romo

Interviewees described feelings of being overwhelmed. One said: “It gets to the point where [the financial uncertainty] just weighs against you. Like, am I worth doing this procedure? […] I’ll never make this much money. I’m never going to be able to pay this off.”

The researchers learned that health-related financial uncertainty led to depression and other mental health issues for many.

Participants described cost-saving measures that may have undermined their health.

These included going without ample food to pay for prescriptions, taking reduced medications than prescribed to make medicines last longer, and having to forgo prescriptions altogether due to their cost.

People reported skipping medical appointments they did not feel they could afford.

Interviewees also reported some positive strategies for dealing with their situation. Dr. Romo explains how constructive efforts to get help revolve around communication: “Seeking information and emotional support from your social network is inherently about communication. Seeking financial help or help in getting to medical appointments is about communication.”

“Advocating for yourself or others in the context of medical care is all about communication. So being able to share information effectively is incredibly important,” she goes on to note.

The interviews show that struggling with medical debt while also facing serious health issues is a one-two punch that takes a significant toll on a person’s overall well-being. As Dr. Romo says: “Our study suggests that the effect is profound. The pandemic and related expenses may make it worse. And this is something we need to be looking at.”