Abstract

Objectives

To examine how household medical debt responds to changes in income and new health events.

Study design

Secondary analysis of a panel survey.

Methods

We analyzed data from 6,599 households in the 2019–2021 waves of the nationally representative US Panel Study of Income Dynamics (PSID) with no medical debt in 2019. We focus on the onset of unpaid medical bills, classifying debt ≥20 % of annual income as high burden and <20 % as low or medium. Using logistic regression, we estimate the impact of changes in household income and onset of chronic conditions on acquiring medical debt.

Results

In our analytic sample, 4.4 % of households experienced the onset of low or medium medical debt, and 1.2 % experienced the onset of high medical debt between the 2019 and 2020 waves of the PSID. Pandemic-related earnings loss increased high medical debt onset by 1.1 percentage points (95 % confidence intervals [95 % CI: 0.2 to 1.9]). The onset of low or medium medical debt rose by 3.4 percentage points (95 % CI: 0.4 to 6.4) among households in which the head or spouse received a new diabetes diagnosis, and by 3.5 percentage points (95 % CI: 1.4 to 5.6) among households with a new arthritis diagnosis. High medical debt onset increased by 1.8 percentage points (95 % CI: 0.2 to 3.3) in households with a new cancer diagnosis.

Conclusions

Unexpected earnings losses and new diagnoses of cancer, diabetes, and arthritis significantly increase the risk of medical debt onset.

• 4.4% of households experienced the onset of low or medium medical debt, and 1.2% experienced the onset of high medical debt
• Income loss increased the risk of high medical debt onset
• New diagnoses of diabetes or arthritis increased the risk of low or medium medical debt onset
• A new cancer diagnosis increased the risk of high medical debt onset