Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We 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. 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 results suggest that debt is an understudied aspect of health stratification.
AnguelovChristopher E.TamboriniChristopher. 2009. “Retiring in Debt? Differences between the 1995 and 2004 Near-retiree Cohorts.” Social Security Bulletin69:13–34.
2.
BravemanPaula A.CubbinCatherineEgerterSusanChideyaSekaiMarchiKristen S.MetzlerMarilynPosnerSamuel. 2005. “Socioeconomic Status in Health Research: One Size Does Not Fit All.” Journal of the American Medical Association294:2879–88.
3.
BrownSarahTaylorKarlPriceStephen Wheatley. 2005. “Debt and Distress: Evaluating the Psychological Cost of Credit.” Journal of Economic Psychology26:642–63.
4.
BucksBrian K.KennickellArthur B.MachTraci L.MooreKevin B.2009. Changes in U.S. Family Finances from 2004 to 2007: Evidence from the Survey of Consumer Finances. Washington, DC: Federal Reserve Board.
5.
BurgardSarah A.SeefeldtKristin S.ZelnerSarah W.2012. “Housing Instability and Health: Findings from the Michigan Recession and Recovery Study.” Social Science & Medicine75:2215–24.
6.
CallahanS. ToddCooperWilliam O.2007. “Continuity of Health Insurance Coverage among Young Adults with Disabilities.” Pediatrics119:1175–80.
7.
Centers for Disease Control. 2010. “Delayed or Forgone Medical Care Because of Cost Concerns Among Adults Aged 18–64 Years, by Disability and Health Insurance Coverage Status: National Health Interview Survey.” CDC: Washington, DC.
8.
ChanKathy P. M.YipPaul S. F.AuJadeLeeDominic T. S.2005. “Charcoal-burning Suicide in Post-Transition Hong Kong.” British Journal of Psychiatry186:67–73.
9.
ConleyDalton. 1999. Being Black, Living in the Red: Race, Wealth, and Social Policy in America. Berkeley, CA: University of California Press.
10.
DimatteoM.GiordaniPatrick J.LepperHeidi S.CroghanThomas W.2002. “Patient Adherence and Medical Treatment Outcomes: A Meta-analysis.” Medical Care40:794–811.
11.
DotyMichelle M.EdwardsJennifer N.HolmgrenAlyssa L.2005. “Seeing Red: Americans Driven into Debt by Medical Bills. Results from a National Survey.” Issue brief, Commonwealth Fund, New York.
12.
DrenteaPatricia. 2000. “Age, Debt and Anxiety.” Journal of Health and Social Behavior41:437–50.
13.
DrenteaPatriciaLavrakasPaul J.2000. “Over the Limit: The Association among Health, Race and Debt.” Social Science & Medicine50:517–29.
14.
DrenteaPatriciaReynoldsJohn R.2012. “Neither a Borrower nor a Lender Be: The Relative Importance of Debt and SES for Mental Health among Older Adults.” Journal of Aging and Health24:673–95.
15.
DuncanGreg J.DalyMary C.McDonoughPeggyWilliamsDavid R.2002. “Optimal Indicators of Socioeconomic Status for Health Research.” American Journal of Public Health92:1151–57.
16.
DwyerRachel E.McCloudLauraHodsonRandy. 2011. “Youth Debt, Mastery, and Self-esteem: Class-stratified Effects of Indebtedness on Self-concept.” Social Science Research40:727–41.
17.
ElofssonStigUndénAnna-LenaKrakauIngvar. 1998. “Patient Charges: A Hindrance to Financially and Psychosocially Disadvantage Groups Seeking Care.” Social Science & Medicine46:1375–80.
18.
EpsteinRobert S.SokolMichael C.VerbruggeRobert R.McGuiganKimberly A.2005. “Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost.” Medical Care43:521–30.
HelmanRuthGreenwaldMathewCopelandCraigVanDerheiJack. 2009. “The 2009 Retirement Confidence Survey: Economy Drives Confidence to Record Lows; Many Looking to Work Longer.” EBRI Brief328.
21.
HerdPamelaGoeslingBrianHouseJames S.2007. “Socioeconomic Position and Health: The Differential Effects of Education versus Income on the Onset versus Progression of Health Problems.” Journal of Health and Social Behavior48:223–38.
22.
HermanPatricia M.RissiJill J.WalshMichele E.2011. “Health Insurance Status, Medical Debt, and Their Impact on Access to Care in Arizona.” American Journal of Public Health101:1437–43.
23.
KahnJoan R.FazioElena M.2005. “Economic Status over the Life Course and Racial Disparities in Health.” The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences60:S76–S84.
24.
KaneSunandaShayaFadia. 2008. “Medication Non-adherence is Associated with Increased Medical Health Care Costs.” Digestive Diseases and Sciences53:1020–24.
25.
KeeseMatthias. 2012. “Who Feels Constrained by High Debt Burdens? Subjective vs. Objective Measures of Household Debt.” Journal of Economic Psychology33:125–41.
26.
KullgrenJeffrey T.GalbraithAlison A.HinrichsenVirginia L.MiroshnikIrinaPenfoldRobert B.RosenthalMeredith B.LandonBruce E.LieuTracy A.2010. “Health Care Use and Decision Making among Lower-income Families in High-deductible Health Plans.” Archives of Internal Medicine170:1918–25.
27.
MayJessica H.CunninghamPeter J.2004. “Tough Trade-offs: Medical Bills, Family Finances and Access to Care.” Center for Studying Health System Change Issue Brief85:1–4.
28.
MeierStephanSprengerCharles. 2010. “Present-biased Preferences and Credit Card Borrowing.” American Economic Journal: Applied Economics2:193–210.
29.
MielckAndreasKiessRaphaelvon dem KnesebeckOlafStirbuIrinaKunstAnton E.2009. “Association between Forgone Care and Household Income among the Elderly in Five Western European Countries: Analyses Based on Survey Data from the SHARE-study.” BMC Health Services Research9:52–9.
30.
MuntanerC.EatonW. W.DialaC.KesslerR. C.SorlieP. D.1998. “Social Class, Assets, Organizational Control and the Prevalence of Common Groups of Psychiatric Disorders.” Social Science & Medicine47:2043–53.
31.
NelsonMelissa C.LustKatherineStoryMaryEhlingerEd. 2008. “Credit Card Debt, Stress and Key Health Risk Behaviors among College Students.” American Journal of Health Promotion22:400–407.
32.
OsterbergLarsBlaschkeTerrence. 2005. “Adherence to Medication.” New England Journal of Medicine353:487–97.
33.
OstroveJoan M.FeldmanPamelaAdlerNancy E.1999. “Relations among Socioeconomic Status Indicators and Health for African-Americans and Whites.” Journal of Health Psychology4:451–63.
34.
RaghunathanTrivellore E.LepkowskiJames M.Van HoewykJohnSolenbergerPeter. 2001. “A Multivariate Technique for Multiply Imputing Missing Values Using a Sequence of Regression Models.” Survey Methodology27:85–96.
35.
ReadingRichardReynoldsShirley. 2001. “Debt, Social Disadvantage and Maternal Depression.” Social Science & Medicine53:441–53.
36.
RodriguezEuniceAllenJosephine A.FrongilloEdward A.Jr.ChandraPinky. 1999. “Unemployment, Depression, and Health: A Look at the African-American Community.” Journal of Epidemiology and Community Health53:335–42.
37.
RossCatherine E.HuberJoan. 1985. “Hardship and Depression.” Journal of Health and Social Behavior26:312–27.
38.
SchnittkerJason. 2004. “Education and the Changing Shape of the Income Gradient in Health.” Journal of Health and Social Behavior45:286–305.
39.
SchnittkerJason. 2005. “When Mental Health becomes Health: Age and the Shifting Meaning of Self-evaluations of General Health.” Milbank Quarterly83:397–423.
40.
SchoenbaumMichaelWaidmannTimothy. 1997. “Race, Socioeconomic Status, and Health: Accounting for Race Differences in Health.” The Journals of Gerontology, Series B: Psychological and Social Sciences52:61–73.
41.
StataCorp. 2011. Stata Multiple-imputation Reference Manual: Release 12. College Station, TX: Stata Press.
42.
SullivanTeresa A.WarrenElizabethWestbrookJay Lawrence. 1989. As We Forgive Our Debtors: Bankruptcy and Consumer Credit in America. New York: Oxford University Press.
43.
SullivanTeresa A.WarrenElizabethWestbrookJay Lawrence. 2000. The Fragile Middle Class: Americans in Debt. New Haven, CT: Yale University Press.
44.
TuHa T. 2004. “Rising Health Costs, Medical Debt and Chronic Conditions.” Center for Studying Health System Change Issue Brief88:1–5.
45.
WallaceBruce B.MacEnteeMichael I.2012. “Access to Dental Care for Low-income Adults: Perceptions of Affordability, Availability and Acceptability.” Journal of Community Health37:32–9.
46.
WenzlowAudra T.MullahyJohnWolfeBarbara L.2004. “Understanding Racial Disparities in Health: The Income-wealth Paradox.” Institute for Research on Poverty Discussion Paper no. 1283-1304, http://irp.wisc.edu/publications/dps/pdfs/dp128304.pdf.
47.
ZeldinCindyRukavinaMark. 2007. Borrowing to Stay Healthy: How Credit Card Debt Is Related to Medical Expenses. New York: Demos.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
