Consumers' Experience in Massachusetts: Lessons for National Health Reform

Based on interviews, explores the impact of the state's 2006 healthcare reform on access to affordable coverage and on medical debt burdens. Discusses remaining issues and outlines lessons for national reform, including on the role of public programs

PLAYING BY THE RULES BUT LOSING How Medical Debt Threatens Kansans' Healthcare Access and Financial Security

The Access Project (TAP) has served as a resource center for local communities working to improve health and healthcare access since 1998. The mission of TAP is to strengthen community action, promote social change, and improve health, especially for those who are most vulnerable. TAP conducts community action research in conjunction with local leaders to improve the quality of relevant information needed to change the health system. TAP's fiscal sponsor is Third Sector New England, a non-profit with more than 40 years of experience in public and community health projects. TAP is affiliated with the Heller School for Social Policy and Management at Brandeis University. The consequences of medical debt can be serious and far reaching. Most directly, those with medical debt experience diminished access to care. However, many are also afflicted with a host of financial problems that can undermine their and their families' economic security. These include being unable to pay for basic necessities; using up all of their savings to pay for medical care; being denied employment; and being turned down from mortgages or renting homes because of damaged credit. This study investigates both the extent and the consequences of medical debt among low-income Kansans. It reports on findings of a survey conducted between May and August of 2005 with 1,058 patients at four community health centers in Kansas-two in Wichita, one in Emporia, and one in Garden City. The survey examined respondents' medical debt from all sources, including hospitals, doctors, dentists, prescription medications, and ambulance services. KEY FINDINGS Medical debt was widespread among survey respondents. It affected majorities of all racial and ethnic groups, as well as those with and without insurance. Nearly two-thirds (63%) of survey respondents reported currently owing money for medical bills. Over half of all racial and ethnic groups reported current medical debt, with immigrants having somewhat lower rates than those born in the United States (43% vs. 57%). Among those in families where all or some people were uninsured, rates ranged between 66 and 72 percent. Even in families where everyone had been insured for the previous year, over half (51%) reported having medical debt. The Access Project Many with medical debt were never informed about the availability of financial assistance by their providers. Among respondents with medical debt, almost 4 in 10 (39%) reported never receiving offers of financial assistance from their medical providers. Among those offered help, the most common form was a payment plan. Only 14 percent of those with medical debt said their bills had been discounted. Medical debt significantly diminished people's access to medical care. Nearly half (48%) of those with medical debt said they had delayed a doctor's visit because of the debt, while nearly 4 in 10 (39%) delayed a dental visit. Of those who delayed care over half said they delayed care out of embarrassment (59%), while almost two-thirds (63%) said they did not want to add to existing debt. One out of six respondents who delayed care said they were refused an appointment because of the debt. Over a quarter of those with medical debt (26%) changed primary care doctors because of money they owed for care. People with medical debt struggled to pay their bills. More than 4 in 10 respondents (41%) with medical debt borrowed money from friends or family to pay their bills, while 2 in 10 (20%) used a large portion of their savings to pay them. Others put bills on their credit cards, took out loans, or borrowed against their homes. Medical debt often resulted in credit, housing, and employment problems. Over half of those with medical debt (51%) said the debt made it harder for them to get loans and access credit. More than half (52%) said the debt contributed to housing problems, including making it harder to pay the rent or mortgage, being turned down from renting a house or apartment, being unable to get a mortgage, or being forced to move. Almost three in 10 (29%) said the debt contributed to employment problems, such as having to increase work hours, having wages withheld, or being denied a job because of poor credit. Medical debt caused reduced access to care and had damaging financial consequences for significant portions of the insured as well as the uninsured. Large portions of those with medical debt in households where all or some family members were uninsured delayed care because of the debt (79% and 70% respectively). However, over half (53%) of those in households where everyone was insured also reported delaying care. Similarly, while over half of those with medical debt in households where some or all family members were uninsured experienced problems getting loans or credit, nearly 4 in 10 (39%) of those in families where everyone was insured also experienced these problems. And, while over half (approximately 57%) of those with medical debt in households where some or all family members were uninsured experienced housing problems because of the debt, these problems affected more than a third (37%) of those in families where everyone was insured as well. "The health insurance is too high. I haven't had a check-up since my daughter was born four years ago. " -Wichita mother of 4 who owes $500 Problems related to medical debt resulted from relatively small amounts of debt. The likelihood of these problems increased dramatically with even relatively small increases in the amount of debt. For example, housing problems affected over a third (35$800. This percentage rose to over half (52%) of those with debts between $800 and$3,500, and to almost three-quarters (72%) of those with debts over $3,500. Similar patterns were observed with respect to the impact of the size of debt on the likelihood of people changing their site of care and experiencing credit and employment problems

2008 Health Insurance Survey of California Farm and Ranch Operators: Overview of Findings

Presents findings on the healthcare costs of the state's farmers and ranchers, including health status, insurance source, reason for uninsurance, healthcare expenditures, payment source, financial burden, and access to care. Discusses policy implications

2008 Health Insurance Survey of California Farm and Ranch Operators: Who Experiences Financial Hardship Because of Health Care Costs?

Analyzes factors affecting California farmers' and ranchers' likelihood of spending more than 10 percent of their income on health care or reporting financial hardship due to medical costs, including source of insurance. Discusses policy implications

2007 Health Insurance Survey of Farm and Ranch Operators

Presents findings on the health insurance status of farmers and ranchers in the Great Plains states and the factors that raise their risk of spending 10 percent or more of their income on health care or reporting financial hardship due to medical costs

Eating Together After Cancer

Thesis (Ph.D.)--University of Washington, 2022Abstract Eating Together After Cancer Jan C. Pryor Kathryn YorkstonDepartment of Rehabilitation Medicine Introduction: Although treatment for medical aspects of dysphagia due to head and neck cancer is well established, knowledge of the range and extent of psychosocial issues related to the impact of dysphagia on social eating specifically has not been clearly determined. Objectives: The primary objective of this study was to explore the psychosocial impact of eating with others on people with dysphagia due to head and neck cancer. Methods: This was a mixed-methods study that utilized focus groups of people with dysphagia to identify key topics related to social eating. These data were used to develop a survey to quantify the range and extent of the psychosocial impact of dysphagia on social eating. Results: Survey data from 53 participants with dysphagia due to head and neck cancer were collected. Findings revealed psychosocial issues related to social eating were common in this participant sample (average time since completion of treatment, 6 years, range 6 months—23 years). Data analysis revealed there were no statistically significant differences in the extent of psychosocial impact between home and public settings. In addition, statistically significant differences in psychosocial impact were not found across a range of topics by people of different swallowing severity levels, with two exceptions. People with severe dysphagia reported that family members went out to eat less frequently due to dysphagia (p < 0.05), and perceived that swallowing problems embarrassed people they eat with in public more than people with mild or moderate dysphagia respectively (p <0.05). People with dysphagia also noticed family members were impacted by dysphagia. Conclusion: Negative social consequences of dysphagia related to eating with others were commonly reported in this study. The persistence of social consequences for years after treatment by people with all levels of swallowing severity suggests the importance of screening for psychosocial issues related to social eating. Investigators hope this study provides increased awareness of the social consequences of dysphagia as well as useful strategies to support people with dysphagia. This study may assist in the development of future assessment tools

Oral history interview with Carol Pryor (OH-008)

Carol Pryor, a member of the Jamaica Plain Committee on Central America (JPCOCA), discusses her background and education; the creation of and her involvement with the Jamaica Plain Committee on Central America in the early 1980s; the January 1983 meeting with Congressman Moakley regarding El Salvador; Moakley’s reaction to the issues brought to his attention by JPCOCA and his pursuit of these issues through his key aide, Jim McGovern; and the activities of the Jamaica Plain Committee during the 1980s to help the cause of Salvadoran refugees. In conclusion, Ms. Pryor expresses how Congressman Moakley’s actions far exceeded the hopes of the Jamaica Plain Committee and how much she enjoyed the experience of helping the Salvadoran people.https://dc.suffolk.edu/moh/1009/thumbnail.jp