Between 27% to 45% of the adult American population is living in a family facing multiple financial burdens related to healthcare, according to a study published in Health Affairs this week.

The authors analyzed data from the 2018-2019 Medical Expenditure Panel Survey — which was conducted by the Agency for Healthcare Research and Quality. 

They found that 27% of people were living in families that faced at least one of the identified financial pressures, but up to 45% faced more broad financial strains. That percentage varied based on sociodemographic factors, specific healthcare needs and insurance coverage.

Overall, the researchers pinpointed that 7.5% of people lived in families with high out-of-pocket expenses and 8.4% lived in families with serious medical debt. 

Nearly 19% of people lived in families that had financial barriers to care — such as avoiding care due to not being able to afford it.

Those percentages differed when looking at socioeconomic factors. 

For example, 18% of people at the lowest income level reported high out-of-cost burdens, compared to only 3% at the highest income level. Out-of-pocket burden was also higher among people with private, nongroup health insurance.

Interestingly, the study also found that having a family member with diabetes was associated with higher out-of-cost burden.

The study sought to analyze the “joint distribution” of three main dimensions of healthcare financial pressure — including out-of-pocket costs, medical debt and barriers to care. The researchers chose to focus on those three in the study because most past research, they noted, has focused on the problems individually rather than jointly.

To gain a complete picture of the financial challenges facing families across the country, researchers took a broader perspective by exploring all three financial problems together.

“Some families face high out-of-pocket spending on insurance premiums and medical care relative to income and assets,” the researchers wrote in the study’s abstract. “Some face medical debt that must be paid off over time. And some face delays or go without needed care for reasons involving cost.”

Ultimately, the researchers concluded that the prevalence of financial pressure among American families underscored the need for solutions to ease it and to help develop new policy insights.

“The wide distribution of financial strain provides context for ongoing reforms in billing, coverage and medical debt, as well as for the urgency felt across the country for healthcare financing reform,” the authors stated.

Additionally, the authors concluded that while relatively few nonsenior adults lived in families that faced multiple problems, many lived in families with at least one.

The authors also pressed lawmakers to learn from the study and use it to inform future health policy, such as expanding federal and state Medicaid policies and acknowledge the importance of the Inflation Reduction Act. They also pointed to the need for more legislation around preventing and reducing medical debt.

For a January 2024 article about a documentary shortlisted for Oscars explores rural healthcare crisis, click here.