Financial Security Has a Major Influence on Population Health, Study Notes

By Dennis Archambault

Financial security is an under-publicized social determinant of care, and a significant aspect of that is medical debt. The cost of health care, especially for those whose insurance policies have high co-pays and deductibles, is significant. And, as with many of the social determinants, it affects Black and people of color at a higher rate than other populations.

A recent study published this year in the Journal of the American Medical Association found that medical debt was associated with more days of poor physical and mental health care, more years of life lost, and higher mortality rates for all causes of death. “Medical debt is increasingly common in the U.S. Little is known regarding its association with population health,” the study notes.

“Certain populations are especially vulnerable to incurring medical debt. These populations include racial and ethnic minority individuals, female individuals, younger individuals, rural residents, those with multiple chronic diseases or serious psychological distress, uninsured individuals, those with high-deductible insurance plans, individuals with limited health insurance literacy, and individuals living in states that have not expanded Medicaid income eligibility under the Patient Protection and Affordable Care Act (ACA).”

During the COVID pandemic, there was considerable discussion about the effect of the disease on our “essential” workers. This is the same population of employed people most affected by the social determinants of care. And those determinants affect the ability of the population to access health services. “Without paid sick leave, some individuals may delay or forgo health care when a life-threatening disease is diagnosed if they cannot afford lost wages. Extended unpaid absences from work may result in job loss and loss of employer-sponsored health insurance coverage,” according to the study.

Decision makers in society, particularly elected officials who make critical decisions on health policy, need to understand the nuances of the many things that factor into health, especially financial security.

Dennis Archambault is vice president of Public Affairs at Authority Health.