Debt Matters: Inequality and Foregone Medical Care

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”- Martin Luther King Jr.

Scholars have long observed disparities in health, health behaviors and stress by socioeconomic position. But there is a limited understanding of what debt means for well-being and how does it influence health care seeking.
In this important (open access) paper “Debt and Foregone Medical Care“, Lucie Kalousova and Sarah A. Burgard assess whether holding various types and amounts of debt may influence access to medical care. They focus on foregone medical care, which surveys frequently define as not going to the doctor (or other health care provider) for cost reasons when the respondent felt that they needed to go. The researchers examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession.
The results were very clear: overall debt and ratios of debt to income and debt to assets were positively associated with foregoing medical or dental care in the past 12 months, even after adjusting for the poorer socioeconomic and health characteristics of those foregoing care and for respondents’ household incomes and net worth. These overall associations were driven largely by credit card and medical debt, while housing debt and automobile and student loans were not associated with foregoing care.
These novel findings by Kalousova and Burgard reveal the complex links between personal debt and foregoing care for cost reasons, and accentuate the importance of evaluating the policy dealing with health, social stratification and inequality.

Kalousova, Lucie and Sarah A. Burgard. 2013. “Debt and Foregone Medical Care.” Journal of Health and Social Behavior 54(2) 204–220.