Medical debt must be addressed upstream through financial assistance programs

By Dennis Archambault

Medical debt is a problem that plagues low-income households struggling to “stay afloat.” It is a major contributing cause of poverty, and some argue that it is actually a social determinant of health. Last month, Michigan established a program that will provide medical debt relief for 210,000 residents of Michigan in partnership with the nonprofit Undue Medical Debt. But public health thinking reminds us that as a social determinant of health, medical debt needs to be addressed upstream, at the systemic level.

Dr. Minal Patel, professor at the University of Michigan School of Public Health whose research focuses on financial burden, healthcare affordability, and non-medical drivers of health, says that “medical debt forgiveness helps (but) it doesn’t fix the broken system that created the debt in the first place.” It only takes a slip and fall on icy pavement to topple a fragile household’s economy. Four in 10 adults are dealing with medical debt, a major driver of financial insecurity and a reason many people avoid medical care, Dr. Patel says. The problem is baked into the system. “Our system all but guarantees it. High prices, inadequate insurance, and inconsistent financial assistance policies leave many with few options.”

Medical debt is not just a financial challenge, as onerous as that may be. It is also a social determinant that leads to a “downward spiral of deferred health maintenance creating greater need for medical care and incurring greater debt… often trapping people in a complicated cycle of poverty,” according to Neighborhood Trust Financial Partners in its study, “RIP Medical Debt.” People become isolated from the health care system resulting in avoiding physician appointments, reducing, or skipping prescriptions entirely, resorting to self-treatment and self-medication, and often leading to unhealthy consumption of alcohol and drugs. In addition to neglecting medical care, respondents in the study indicated that the “financial toxicity from unpaid medical bills” deteriorates their mental health, complicating their physical condition. And without adequate financial resources, people are unable to access psychotherapy, which would help in their healing.

Authority Health Centers helps prevent this scenario through a sliding fee discount schedule. No person is denied health care services due to their inability to pay for services, based on federal poverty guidelines. Any fees or payment required for health services are reduced or waived. For a detailed explanation of our sliding fee schedule, contact the Authority Health Finance Department at 313-871-3751.

Disease and injury are difficult enough to recover from, much less having to live with the burden of unresolved medical debt for years.

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