Medical Problems Cause Half of Personal Bankruptcies

Majority of debtors were insured when illness struck

WEDNESDAY, Feb. 2, 2005 (HealthDayNews) -- Illness and medical bills contributed to roughly half the personal bankruptcy filings in 2001, affecting as many as 2.2 million Americans, a new Harvard study says.

More than 75 percent of the filers had insurance, but many of them lost coverage during their illness, the research showed.

The study, which appears in the Feb. 2 issue of Health Affairs, provides a rare -- and stark -- glimpse into the medical causes of bankruptcy in the United States.

People who succumb to medical debt are mostly middle-class or working-class people who own their own homes and have at least some college education, the study found.

"I think the message that we take away is, really, nobody is safe in our country. Short of (Microsoft Chairman) Bill Gates, if you're sick enough long enough, you're likely to be financially ruined," cautioned study author Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School.

"We're all one serious illness away from bankruptcy," he added.

Carol Pryor, a senior policy analyst at The Access Project in Boston, has studied the issue of medical debt and its "ripple effect" on people's lives. It can ruin an individual's credit and make it difficult to obtain and pay for medical appointments, she said. And as more health-care costs get shifted to consumers in the form of higher premiums, deductibles and co-insurance, the problem is only likely to escalate, she added.

"The medical debt issue is interesting," Pryor said, "because it just points up so many fault lines in our system."

With the cooperation of bankruptcy judges in five federal districts, the study authors distributed questionnaires to debtors at their mandatory meetings with court-appointed trustees. A total of 1,250 questionnaires -- 250 per district -- were collected, providing data on demographics, housing and specific reasons for filing bankruptcy.

Additional information from 521 homeowners filing for bankruptcy boosted the total sample to 1,771. Follow-up telephone interviews were completed with 931 families.

More than a quarter of those surveyed cited illness or injury as the specific reason for bankruptcy. When investigators examined how frequently illness and medical bills contributed to bankruptcy, the percentages swelled.

Close to half met the researchers' definition of a "major medical bankruptcy," meaning they either cited illness or injury as a specific reason for bankruptcy, had more than $1,000 in uncovered medical bills in the past two years, lost at least two weeks of income from work due to illness or injury, or mortgaged a home to pay medical bills.

More than half met the criteria for "any medical bankruptcy." This group included people who had a major medical bankruptcy or anyone reporting addiction, uncontrolled gambling, birth of a child, or death of a family member as a cause of bankruptcy.

Medical debtors were much more likely than other bankruptcy filers to have experienced a gap in health insurance coverage, the study revealed.

In follow-up interviews, researchers found that the people whose bankruptcy had a medical cause were more likely than other debtors to do without such basic necessities as phone service, water or electricity or food. Three-fifths went without a needed doctor or dentist visit, while nearly half failed to fill a prescription.

Among policymakers and opinion leaders, there's little dispute that the nation's employer-based health insurance system is flawed and vast agreement that something needs to be done to help the more than 43 million Americans who lack insurance coverage.

But that's where the consensus ends and philosophical divisions begin. To ameliorate the problem of medical bankruptcy, the authors of the new research argue for a national insurance system divorced from the existing job-based insurance model.

Others favor targeted, incremental fixes. The Bush administration, for example, proposes making greater use of health savings accounts and allowing businesses to band together to offer health insurance coverage through "association health plans."

"That's part of the solution," agreed Grace-Marie Turner, founder and president of the Galen Institute, a research organization that promotes free-market ideas in health care. She also endorses the Bush plan to allow people to buy insurance across state lines.

"It's just so important that people have more choice to buy the kind of insurance they know protects them," she said.

Former House Speaker Newt Gingrich also has a vision for reforming health care. In Saving Lives & Saving Money: Transforming Health and Healthcare, he and co-authors Anne Woodbury and Dana Pavey propose, in part, a national reinsurance pool to spread the risk of insuring people who incur extremely high medical costs.

"It's another something to try that is more aligned with the American value set," said Woodbury, chief health advocate of Gingrich's Center for Health Transformation in Washington.

But proponents of a national health system disagree. Health savings accounts, which are tied to high-deductible health plans, have the potential to skim away affluent, healthier individuals, leaving sicker people in traditional health plans and putting them at risk of higher premiums, Pryor said.

Meantime, Himmelstein suggests Canada's low rate of medical bankruptcy is the result of a better medical and social insurance system. Every other developed nation has solved the problem, he asserted. "Why should Americans have second-class health care?"

More information

Read this story from the Pittsburgh Post-Gazette on medical bills and bankruptcy.

SOURCES: David Himmelstein, M.D., associate professor, medicine, Harvard Medical School, Boston, and chief, division of social and community medicine, Cambridge Hospital, Cambridge, Mass.; Carol Pryor, senior policy analyst, The Access Project, Boston; Grace-Marie Turner, founder and president, Galen Institute, Alexandria, Va.; Anne Woodbury, chief health advocate, Center for Health Transformation, Washington, D.C.; Feb. 2, 2005, Health Affairs
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