Of all families with medical bill problems, two-thirds have difficulty paying for basic necessities—rent, mortgage payments, transportation or food

Almost 20 million American families had problems paying medical bills in 2003, forcing many to make tough trade-offs between medical, food and housing expenses, according to a national study released today by the Center for Studying Health System Change (HSC).

Uninsured families are more likely to have medical bill problems, but two-thirds of families with problems paying medical bills—about 13.5 million families—have health insurance coverage, according to findings from HSC's Community Tracking Study 2003 Household Survey, a nationally representative survey involving information on about 25,400 families and 46,600 people.

Of all families with medical bill problems, almost two-thirds reported difficulty paying for other basic necessities—rent, mortgage payments, transportation or food—as a result of medical debt, the study found. And the 43 million people in the nearly 20 million families with medical bill problems also reported much greater difficulty getting medical care because of cost concerns—one in three did not get a prescription drug, one in four delayed care and one in eight went without needed care.

"Medical debt is a problem for one out of seven American families and often reaches a serious enough level to negatively affect family finances and access to care," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

"For families with existing medical bills—especially lower income families—the fear of generating additional medical bills and some providers' unwillingness to treat patients with outstanding debts may force many to postpone or forgo needed medical care because of out-of-pocket costs," said HSC Senior Health Researcher Peter J. Cunningham, Ph.D., who co-authored the study with HSC Health Research Assistant Jessica H. May.

The study's findings are detailed in a new HSC Issue Brief—Tough Trade-offs: Medical Bills, Family Finances and Access to Care.

Other key findings include:

• Uninsured families—all family members are uninsured—are about twice as likely to report medical bill problems as insured families (23.7 % for uninsured families compared with 11.4 % for insured families). But insured families—all members have coverage—comprise the majority (68%) of families with medical bill problems.
• About one-fifth of low-income families—those with family incomes less than 200 percent of the federal poverty level, or $36,800 for a family of four in 2003—had problems paying medical bills, compared with 7.4 percent of families with incomes 400 percent of poverty or higher.
• Among insured families, the prevalence of medical bill problems varies by type of insurance coverage. Elderly families—the family respondent was 65 or older—covered by Medicare were the least likely to report medical bill problems (7.1%) compared with nonelderly publicly insured families (17.2%) and nonelderly privately insured families (11.1%).
• Of all families with medical bill problems, 63.1 percent reported difficulty paying for other basic necessities—such as rent, mortgage payments, transportation or food—as a result of their medical bills. More than 60 percent of families with medical bill problems also reported being contacted by a collection agency, and about half reported putting off a major purchase or borrowing money. Almost all families with medical bill problems (94%) reported at least one of these adverse financial effects and nearly a quarter experienced all four negative consequences.
• People in families with medical bill problems were four times more likely to report delaying care in the past year because of cost concerns and five times more likely to report an unmet medical need in the past year because of cost, compared with people in families without bill problems.
• More than 30 percent of people in families with medical bill problems reported they did not get prescription drugs because of cost, compared with 7 percent of people in families without bill problems.