Patricia Herman, Jill Rissi, and Michele Walsh are the authors of an interesting study in the August 2011 issue of the American Journal of Public Health, which examines the relationship between insurance status, medical debt, and access to care in Arizona. In a simple model, they find that insurance status seems to stave off some degree of medical debt. Specifically, an additional 9 percent of the uninsured population has medical debt relative to the insured. However, once they start controlling for things–estimating a model that much more closely approximates the way the world works–they find that insurance status isn’t a significant factor.
On the other hand, they find that having inconsistent coverage puts people at much greater risk for accumulating medical debt, struggling to pay their bills, and delaying or forgoing needed health care. In fact, compared to the consistently insured, those with inconsistent coverage have 2.5 times the odds of having problems paying their medical bills, nearly 6 times the odds of forgoing needed care, and more than 4.5 times the odds of forgoing needed medications. These are big effects. The authors mention them, but they don’t really focus on them enough, in my opinion, given their magnitude.
Their take seems to be that insurance status doesn’t matter much. My take, using their results, is that insurance status matters very much, because any lapse in coverage subjects the individual to the risks of high out-of-pocket costs, which also seems, understandably, to influence care-seeking behavior. I’d like to hear more from the authors and am going to invite them to respond here on the blog. Hopefully, others will engage them as well.