Primary Submission Category: Health care/services
Medical debt and foregone mental health care due to cost among U.S. adults, 2023–2024
Authors: Kyle Moon, Katherine Miller, Sandro Galea, Catherine Ettman,
Presenting Author: Kyle Moon*
Background. There is a substantial treatment gap for mental health care in the U.S. that may be exacerbated by medical debt.
Methods. This study analyzes data from the COVID-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, a nationally representative, longitudinal panel of U.S. adults. The exposure was past-year medical debt, self-reported in 2023. The outcome of interest was the probability that individuals did not see a mental health care provider when they wanted to in the past year due to cost, measured in 2024. We lagged the exposure to account for the temporality of medical debt and forgone care. Sampling weights were used to account for sampling probabilities and nonresponse. We fit a series of logistic regression models that predicted the probability of foregone mental health care as a function of medical debt and report results as average marginal effects.
Results. Among 1,821 adults, 276 (15.3%) reported medical debt, of whom 121 (6.4%) incurred <$1,000, 107 (6.1%) incurred $1,000–$4,999, and 48 (2.8%) incurred ≥$5,000. Any medical debt was associated with a 17.3 percentage point (pp) increase in the probability of foregoing care [95% CI: 11.8, 22.8] in the next year, after adjusting for sociodemographic characteristics. Compared to those with no medical debt, <$1,000 in medical was associated with a 11.7 pp [95% CI: 4.4, 19.0] increase, $1,000–4,999 in medical debt was associated with a 17.6 pp [10.4, 24.7] increase, and ≥$5,000 was associated with a 28.1 pp [15.6, 40.6] increase in foregoing care.
Conclusions. There may be a dose-response relationship with medical debt and the probability of unmet mental health care needs, with higher medical debt associated with higher probability of foregoing care in US adults. These results suggest that financial assets may influence health care seeking behavior. Policy interventions to stem the rising tide of medical debt in the U.S. may aid in addressing unmet needs for mental health care.