Gender Differences in
Fi
Financial
i l Consequences
C
off
Medical Debt
Jacqueline C. Wiltshire, PhD MPH
Sandi Brown, BS
Tyra Dark, PhD MA
Alicestine D. Ashford, EdD, MPH
AcademyHealth Gender & Health Interest Group Meeting
June 27, 2009
Introduction

Medical debt (MD) negatively impacts access & use
of health care (Collins et al., 2008; Doty et al., 2005)

Financial barriers to health care associated with
poor health outcomes (Rahimi et al., 2006)

2/3 of Americans struggled
gg
with MD in 2007
compared to 2/5 in 2003 (Collins et al., 2008; Doty et al., 2005)


MD source of personal bankruptcy (Seifert, 2004; Himmelstein et al.,
2005))
US economic crisis: MD is burgeoning public health
problem

jjob
b loss
l
& loss
l
off insurance
i
coverage, diminishing
insurance coverage & rising health care cost
Introduction

Women disproportionately impacted by MD
(Collins
et al., 2008;)

Women have more negative medical care
consequences than men (Collins et al., 2008;)



Delay
D
l medical
di l care
Ration medication
However, unclear how women differ from men
However
on financial consequences of MD
Objectives


Examine gender differences in financial
q
of MD
consequences
Research Questions:


Overall, do women experience more negative
Overall
financial consequences of MD than men?
Does ttype
pe of MD conseq
consequence
ence vary
a b
by gende
gender??
Methods: Data & Analytic Sample

Cross-sectional analysis of 2003-04 Household
component of the Community Tracking Study (CTS)



National survey tracking healthcare system changes
and effects on individuals
Population: Civilian non-institutionalized individuals in
the US (n=46,587)
Analytic
y sample
p

4,791 individuals 18yrs+ reporting problems paying
for medical bills in proceeding 12 months
 1,948
1 948 Men
M & 2,843
2 843 women
Methods: Dependent Variables

Financial Consequences of MD Measures:

Contacted by a collection agency (yes/no)

Problems paying for other necessities (yes/no)

Put off major purchases
purchases, such as a new
home or car (yes/no)

Take money out of savings (yes/no)

Had to borrow money (yes/no)

I di t variable:
Indicator
i bl All financial
fi
i l consequences
Independent Variables

Predisposing



Enabling
g


Key independent variable: Gender
Age, race/ethnicity, marital status, education
Income (% of federal poverty level), type of
insurance, usual source of care, employment,
rurall living,
li i
geographic
hi region
i
Need

P
Perceived
i d health
h lth status
t t
M th d Statistical
Methods:
St ti ti l Analysis
A l i

Descriptive and bivariate analyses


Binomial logistic regression


Frequencies
q
and percentages
p
g
Odds ratios & 95% confidence intervals
Analyses performed in SUDAAN

Account for complex survey design
Table 1: Comparison of Selected Sample
Characteristics by Gender (Weighted %)
Total
Male
Female
(n=4,791)
((n=1,948)
,
)
(n=2,843)
< 12 yrs education
24.0
26.9*
21.8
Low income (0
(0-199%
199% of FPL)
49.8
47.7
51.5*
51.5
Unemployed
44.6
37.9
49.9*
Uninsured
d
28 3
28.3
3 6*
31.6*
2 6
25.6
No usual source of care
13.9
18.0*
10.6
Poor/fair health
31.1
25.6
35.8*
* Gender difference statistically significant at 0.05 level
Table 2: Financial Consequences by Gender
Total
Male
(Weighted %)
Female
(n=4
(n
4,791)
791) (n=1,948)
n=2 843)
(n=1 948) (n=2,843)
All financial consequences
C t t db
Contacted
by collection
ll ti
agency
Put off major purchases
94.1
60 9
60.9
94.1
62 0
62.0
94.1
60 1
60.1
51.4
52.3
50.8
Used savings
57.4
60.0*
55.4
Borrowed money
44 7
44.7
42 6
42.6
46 4*
46.4
Problems paying for other
necessities
61.9
60.2
63.3*
* Gender difference statistically significant at 0.05 level
Table 3: Odds Ratios & 95% CI for Gender
Differences in Financial Consequences of Medical Debt
All financial Contacted by Put off major
consequences
q
collection
purchases
p
agency
Unadjusted
Male (vs Female)
Adjusted: predisposing
& enabling factors
Male (vs Female)
0.99
(0.80, 1.22)
1.08
(0.97, 1.21)
1.07
(0.95, 1.20)
1.14
(0.89, 1.46)
1.10
(0.98, 1.23)
1.09
(0.97, 1.22)
Fully adjusted
1 28
1.28
1 16
1.16
1 14
1.14
Male (vs Female) (1.02, 1.59)* (1.03, 1.31)* (1.02, 1.28)*
* Statistically significant at p ≤ 0.05
Table 3 cont: Odds Ratios & 95% CI for Gender
Differences in Financial Consequences of Medical Debt
Used Savings
Unadjusted
j
1.20
Male (vs Female) (1.08, 1.33)*
Adjusted: predisposing
& enabling factors
Borrowed
money
Problems
paying for
necessities
0.86
0.88
(0.77, 0.95)* (0.79, 0.99)*
1.24
1
24
Male (vs Female) (1.12, 1.38)*
0.97
0
97
(0.87, 1.09)
0.99
0
99
(0.89, 1.10)
Fully
ll adjusted
dj
d
1.28
Male (vs Female) (1.15, 1.42)*
1.04
(0.93, 1.16)
1.04
(0.93, 1.17)
* Statistically significant at p ≤ 0.05
Summary


Overall, men report more financial consequences
of MD than women
Men more likely than women:



Contacted by a collection agency
Put off major purchases & use savings
Enabling and need factors confound the
relationship between gender and financial
consequences of MD
Policy Implications

Need for policymakers to address health
care reform



Increase access to care
Improve affordability of care
Ensure health care reform strategies are
relevant
e e a t for
o men
e a
and
d women
o e
Thank You!
Questions?
Table 3: Odds Ratios & 95% CI for Gender
Differences in Financial Consequences of Medical Debt
All financial Contacted by Put off major
consequences collection
purchases
agency
Unadjusted
Male (vs
( Female)
F
l )
Adjusted:
predisposing factors
Male (vs Female)
0.99
(0 80 1.22)
(0.80,
1 22)
1.08
(0 97 1.21)
(0.97,
1 21)
1.07
(0 95 1.20)
(0.95,
1 20)
1.04
(0.84, 1.28)
1.11
(1.00, 1.24)
1.06
(0.94, 1.19)
Adjusted:
predisposing &
Enabling
Fully adjusted
1.28
1.16
1.14
Male (vs Female)
(1.02, 1.59)* (1.03, 1.31)* (1.02, 1.28)*
16
* Statistically significant at p ≤ 0.05