Health care debates can send people into a spiral of financial disadvantage. This includes a lack of security and security in personal life, housing and work.
According to the U.S. Centers for Disease Control and Prevention, traditionally social determinants of health (SDOH) are thought to affect a wide range of health risks and outcomes as a condition of where people live, learn, work and play. I came. (CDC). This includes factors such as housing, food and nutrition, transportation, social and economic mobility, education and environmental conditions.
However, in recent studies JAMA network open Identify new types of SDOH that exacerbate patient problems with traditional SDOH factors. This study shows that unpaid medical bills can lead to a chain reaction of worsening his SDOH, suggesting that affordable medical bills are themselves his SDOH.
Researchers concluded that nearly one-fifth of U.S. households, including many with seemingly good health insurance and middle-class incomes, are indebted to medical care.
“Medical debt builds up, leaving many unable to pay their utility bills and deteriorating housing and food security. ,” writes lead author David Himmelstein, M.D., Ph.D., of the City University of New York at Hunter College. college, and his colleagues. “Thus, unaffordable health care costs may themselves constitute SDoH, leading to a vicious cycle of poor health and financial insecurity.”
Contribution of SDOH to health outcomes
According to the United States, clinical care is estimated to influence only 20% of the variation in health outcomes at the county level, while SDOH influences as much as 50%, with socioeconomic impacts such as poverty, employment and education. factors have the greatest impact on health outcomes. Department of Health and Human Services (HHS).
SDOH plays a key role in advancing the many health inequalities in the United States that persist due to race, ethnicity, sexual orientation, gender identity, and disability. There are also economic and community level factors such as geographic location, poverty status and employment.
For example, Blacks, Latinos, Native Americans, Alaska Natives, Asian Americans, Native Hawaiians, Pacific Islanders, LGBTQ+, individuals, people living in rural areas, people with disabilities are white, heterosexual, They live worse lives than those who live in urban areas. people without disabilities. According to HHS, these disparities exist in many health outcomes, including infant and maternal mortality, heart disease, diabetes, hypertension, chronic disease, disability, cancer, mental illness, substance use and life expectancy. To do.
the burden of medical debt
According to a survey Himmelstein and his colleagues reported, 1 in 11 American men, 1 in 8 women, and nearly 1 in 5 households have medical debt, making it one of the most vulnerable in society. Only the high-income and most educated segments are relatively spared.
The average health care debt across the population was $2,306 per US adult in 2018, or about $4,671 per household. Among racial and ethnic groups, non-Hispanic black adults had the highest medical debt rates (16.5%) and non-Hispanic Asian adults had the highest. was the lowest (4.5%). Adults with medical debt reported about twice as much out-of-pocket medical costs as other medical debtors, who also paid slightly more for their premiums.
In addition to Himmelstein’s study, many other researchers have established a relationship between medical debt and SDOH.in an editorial of jam Last year, University of Michigan researchers Carlos Mendes de Leon, M.D. and Jennifer Griggs, M.D., M.P.H. discussed the impact of
Mendez de León and Griggs found that medical debt overtook all other forms of debt in the United States in 2014, with the highest amounts of medical debt tending to be associated with zip codes with the lowest average income levels for people. It points to a study that found that .
Using this research, here are four reasons why affordable health care itself is SDOHH.
Additional burden for those who are in poor physical condition
Not surprisingly, people who experience poor or worsening health conditions, especially hospitalizations, are at higher risk of incurring medical debt. For example, cancer patients appear to be at particularly high risk of financial problems stemming from both health care costs and unemployment.
health insurance is often not enough
For those who become disabled or newly hospitalized, health insurance offers only partial protection, and high deductible plans and Medicare Advantage leave participants particularly vulnerable to debt. It looks like you are at risk.
Deviation from necessary care
Researchers conclude that health care debt prevents people from seeking or receiving the care they need, often leading to delayed diagnosis and worsening of existing conditions. is also associated with premature death.
Worse other SDOH
Health care debt is the largest overall cause of personal debt, sending people into a “spiral of financial disadvantage” including lack of stability and security in their personal lives, housing and work, and social stigma. There is a possibility that
Medical debt is a pervasive problem in the United States, where patients refrain from spending on essentials such as food, heat, and electricity to avoid paying medical bills, causing medical bill avoidance, stress, and poor health. I’m here. Since medical debt accrual often causes many downstream problems for patients, medical debt itself should be viewed as a social determinant of health and the medical industry should treat it as such.
Ryne Natzke is Senior Vice President of Growth and Strategy at Sphere.
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