Medical debt is associated with significant delays in dental, medical, and mental health care among U.S. adults, even for those who have health insurance, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health released on Mar. 11.
The findings highlight the impact of financial barriers on access to routine and preventive care. Delaying necessary treatment can lead to missed prevention opportunities and increase the risk of developing more serious conditions over time.
The study found that 42.3% of people with medical debt delayed dental care compared to 17.7% without debt; 23% delayed medical care versus 5.3% without debt; and 14% delayed mental health care compared to 5% without debt. The research also showed that uninsured adults were more likely to defer medical care due to debt than those with commercial insurance—over 19% of uninsured adults reported having medical debt, compared with lower rates among those with Medicaid (13%), commercial insurance (9%), or Medicare (8%).
Researchers used data from the 2023 National Health Interview Survey, which included nearly 30,000 adults aged 18 or older across the United States. More than one in ten participants reported experiencing problems paying or being unable to pay any type of medical bill in the past year.
The authors noted that while deferred care was common across all types of insurance coverage, dental care appeared most sensitive to financial hardship because it is often not included in standard health plans and typically requires separate coverage with limited benefits. They also pointed out that poor dental health has been linked to heart disease and cognitive decline.
"Policies that address affordability and the cascading toll of medical debt are critical to mitigating the health and economic impact of deferred care," said first author Kyle Moon, a PhD candidate in the Bloomberg School's Department of Mental Health.
The study acknowledged limitations such as reliance on self-reported data for both financial hardship and deferred care, which may be subject to recall bias. The paper was co-authored by Kyle J. Moon, Nora V. Becker, Katherine E.M. Miller, and Catherine K. Ettman.
