Experiencing Financial Hardship Associated With Medical Bills and Its Effects on Health Care Behavior: A 2-Year Panel Study
Abstract
Using 2-year panel data, this study examined (1) whether experiencing financial hardship associated with out-of-pocket medical expenditures affected delaying/missing necessary health care in the following year; (2) whether such financial hardship mediated the effects of predisposing, enabling, and need characteristics on timely health care access (i.e., significant indirect effects); and (3)whether such mediating effects are different by chronic health status (i.e., moderated mediation) among U.S. adults. The 2011 National Health Interview Survey was linked to the 2012 Medical Expenditure Panel Survey. The sample includes 8,993 adults aged between 26 and 64 years. Among them, 1,089 reported having at least one chronic health condition that had caused activity limitations. Multiple-group path analysis was conducted using Mplus 7.2. Approximately 35% experienced financial difficulties paying medical bills, including 28% who were currently paying off medical debts. Almost 14% of the respondents reported delayed/missed necessary medical treatments. In addition to direct effects, predisposing, enabling, and need factors affected access to care indirectly via financial hardship, although significant moderated mediation was found by chronic health status. However, different from the Andersen’s behavioral model of health service utilization, the effect of financial hardship due to medical bills as a barrier to the timely use of necessary health services was not smaller among adults with chronic health conditions. Policy alternatives should be explored to provide affordable financing programs and adequate safety net health services to reduce the financial burden of health care for those who are financially vulnerable, especially those suffering from chronic health conditions.
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Women may be more negatively impacted by medical debt.
“may be more negatively impacted by medical debt (Choi, 2018)”
From Debt, Incarceration, and Re-entry: a Scoping Review (2021) · cites this paper as Choi, 2018
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- Authors
- Choi, S.
- Affiliations
- University of Tennessee at Knoxville (US)
- Corresponding author
- Choi, Sunha
- ORCID
- Choi, Sunha
- Venue
- Health Education & Behavior
- Publisher
- SAGE Publications
- Published
- 2017-11-08
- Volume
- 45
- Issue
- 4
- Pages
- 616-624
- ISSN
- 1090-1981 (ISSN-L)
- 1552-6127
- OpenAlex
- W2767414835
- Cited by
- 25
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 4 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 6
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Education & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- financial hardship, medical bills, out-of-pocket medical expenditure, health care access, medical debt, chronic disease, Andersen Behavioral Model, moderated mediation, health care utilization, financial burden of health care
- MeSH terms
- Adult, Health Expenditures, Female, Health Status, Health Surveys, Humans, Insurance, Health, Male, Middle Aged, Patient Acceptance of Health Care, Poverty, United States, Health Behavior
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