Healthcare for the 99% Education of the Week for 1/22/12: Bankruptcy & Healthcare in The US

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Healthcare for the 99% Education of the Week: Bankruptcy & Healthcare in The US

The following is a brief summary of a journal article and two abstracts that examine the link of medical expenses and bankruptcy (Prepared by D. Lugassy for 1/22/12 HCF99 Meeting)

1) Himmelstein DU, Thorne D, Warren E, Woolhandler S. Medical bankruptcy in the United States, 2007: results of a national study. Am J Med. 2009 Aug;122(8):741-6. Epub 2009 Jun 6.

-Random national sample of 2314 bankruptcy filers in 2007

-Bankruptcies as “medical” based on debtors’ stated reasons for filing, income loss due to illness, and the magnitude of their medical debts

62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income

78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid

-2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%, Odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001


2) Y. Zafar, A. M. Goetzinger, R. Fowler, et. Al. Impact of out-of-pocket expenses on cancer care. J Clin Oncol 29: 2011 (suppl; abstr 6006)

-127 patients were enrolled, all were insured; 64% had Medicare or Medicare plus supplemental insurance. 22% were employed, 51% were retired, and 73% had annual household income <$40,000. 45% perceived a significant or catastrophic financial burden with OOPE. OOPE averaged $1266/month

-The largest proportion of OOPE was attributed to prescription medication ($523/month, 41%). Other monthly costs included: medical equipment ($197; 14%), travel ($122; 10%), special diet ($72; 6%), and non-prescription drugs ($68; 5%)

-To cope with OOPE, 52% spent less on food and clothing, 76% spent less on leisure activities like eating out or movies, 47% used all or part of their savings, 30% did not fill prescriptions

-20% took less medication than prescribed, and 49% borrowed money to pay for prescriptions


3) S. D. Ramsey, C. R. Fedorenko, K. S. Snell, et. al. Cancer diagnosis as a risk factor for personal bankruptcy. J Clin Oncol 29: 2011 (suppl; abstr 6007)

-Newly diagnosed first primary cancers between 1995-2009, excluding cancers in situ or diagnosed at death

-Authors calculated the conditional probability of personal bankruptcy (chapters 7 and 13)

-231,799 cancer cases; 4,805 (2.1%) filed for bankruptcy

-Median time to bankruptcy was 2.5 years

-Lung, thyroid, and leukemia/lymphoma cancers: highest conditional probabilities at 1 year

-Bankruptcy risk was higher for lung, colorectal and breast cancer cases receiving surgery and chemotherapy

-Patients over age 65, who are typically on Medicare, have a much lower risk of bankruptcy than younger patients.


Bottom Line:

-In the U.S. your ability to work/sustain a job is strongly linked to your ability to pay for medical care and avoid personal bankruptcy

-Having private or public health insurance does NOT save you from bankruptcy

-Cancer is a recognized risk factor for personal bankruptcy in the U.S.

-You are ONE serious medical illness (ie. cancer) away from personal bankruptcy living in the US, a concept that other countries look at as inconceivable!!!

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