The goal of this study is to estimate the direct, causal impact of medical debt on health care utilization, mental health, and wellbeing of patients. The investigators will conduct a survey to measure the impact of the debt forgiveness on health care use, mental health, and wellbeing. The survey will be administered to approximately 17,000 subjects of a recent medical financial intervention. In that prior intervention, a non-profit charity, RIP Medical Debt, purchased and abolished medical debt for a randomly selected about 6,000 (out of the 17,000) individuals. In this current protocol, the investigators will administer the survey, and will compare surveyed outcomes of subjects who received and did not receive the intervention.
This study will estimate the direct, causal impact of medical debt on health care utilization, mental health, and wellbeing of patients. To do so, the investigators will administer a survey to approximately 17,000 subjects of a recent medical financial intervention. In that intervention, a non-profit charity, RIP Medical Debt, purchased and abolished medical debt for a randomly selected about 6,000 (out of the 17,000) study subjects. In this current protocol, the investigators will compare surveyed outcomes of subjects who received and did not receive the medical debt abolishment intervention. Because debt abolishment was randomized, comparing surveyed outcomes of treated and control subjects in the cross-section will allow the study to estimate the causal impact of the medical debt abolishment. The survey will measure the effects of medical debt on three sets of outcomes: (i) health care utilization, as measured by medical care visits, prescription drug utilization and adherence, and unmet need for medical care; (ii) mental health, as measured by validated screens for depression and anxiety; and (iii) subjective wellbeing, as measured by self-reported health, forgone consumption, and financial strain. This study would be the first to provide a direct, causal connection between the rising personal debt associated with U.S. health care and the health outcomes of its recipients.
Study Type
OBSERVATIONAL
Enrollment
17,000
A non-profit charity, RIP Medical Debt, bought and retired medical debt for individuals that were assigned to the treatment group.
UCLA IRB
Los Angeles, California, United States
RECRUITING8-item Patient Health Questionnaire (PHQ-8) Depression Scale
Scores on the 8-item Patient Health Questionnaire depression scale range from 0 to 24, with higher scores indicating greater severity of depression.
Time frame: An average of 12 months after the intervention.
Received Needed Health Care
Binary response to: "If you needed medical care in the last 12 months, did you get ALL the medical care you needed?" (Health Care Utilization domain)
Time frame: An average of 12 months after the intervention.
Received Needed Rx
Binary response to: "If you needed prescription medications in the last 12 months, did you get all the prescription medications you needed?" (Health Care Utilization domain)
Time frame: An average of 12 months after the intervention.
7-item Generalized Anxiety Disorder (GAD7) Scale
Scores on the 7-item Generalized Anxiety Disorder Scale range from 0 to 21, with higher scores indicating greater severity of anxiety (Mental Health Domain).
Time frame: An average of 12 months after the intervention.
Stress
Binary response to: "Stress means a situation in which a person feels tense, restless, nervous or anxious or is unable to sleep at night because his/her mind is troubled all the time. Do you feel this kind of stress these days?" (Mental Health Domain)
Time frame: An average of 12 months after the intervention.
General Health
Response to: "In general, would you say your health is: Excellent, Very Good, Good, Fair, or Poor?" (General Health Domain)
Time frame: An average of 12 months after the intervention.
Happiness
Response to: "Taken all together, how would you say things are these days - would you say that you are Very Happy, Pretty Happy, or Not Too Happy?" (Subjective Wellbeing Domain)
Time frame: An average of 12 months after the intervention.
Problems paying other bills
Response to: "Besides medical bills, have you had problems paying other types of bills in the past 12 months?" (Financial Stress Domain)
Time frame: An average of 12 months after the intervention.
Changes in spending due to medical debt
Indexed response to: "As a result of medical bills have you cut back on spending in the past 12 months on i) basic necessities (like food, heat or housing, or other basic household items), ii) Big-ticket items (like cars, furniture, or appliances); iii) business investments?" (Financial Stress Domain)
Time frame: An average of 12 months after the intervention.
Changes in borrowing due to medical debt
Indexed response to: "As a result of medical bills, in the past 12 months, have you i) Increased your credit card debt, or charge card debt? ii) Borrowed money from a payday lender?; iii) Borrowed from friends and family?; iv) Used up all or most of your savings?; v) Increased debt on other lines of credit?" (Financial Stress Domain)
Time frame: An average of 12 months after the intervention.
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