High medical debt leads to significant delays in routine and preventive care

Medical debt is associated with deferred dental care, medical care, and mental health care, even among people with health insurance, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The study found that 42.3% of people with medical debt delayed dental care compared with 17.7% of those without-almost 2.4 times as many; 23.0% of people with medical debt delayed medical care compared with just 5.3% of those without-about 4.3 times as many; and 14% of people with medical debt delayed mental health care compared with 5% of those without-nearly three times as many. 

Uninsured adults were more likely to defer medical care when experiencing medical debt compared to those covered by commercial insurance-coverage provided by private non-government companies. More than 19% of uninsured adults, 13% of adults with Medicaid, 9% of adults with commercial insurance, and 8% of adults with Medicare reported medical debt. The share of deferred care for both mental health and dental needs was comparable among those who are insured and uninsured.

This study adds to a growing body of research that shows that people facing financial barriers to care experience poorer physical and mental health, higher mortality rates, and increased utilization of high-cost resources that could have been averted with preventive and routine care. However, previous research has not compared which types of care are most often deferred by people experiencing medical debt.

This study was published in the Journal of General Internal Medicine on March 10.

For their analysis, the researchers used data from the 2023 National Health Interview Survey, a nationally representative sample of U.S. adults 18 or older with fixed household addresses. 

More than 10% of the nearly 30,000 adults who participated in the survey reported medical debt, defined as experiencing problems paying or being unable to pay any medical bills in the past 12 months, including bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home, or home care.

While findings remained consistent across insurance types, the association between medical debt and deferred medical care was significantly higher among uninsured adults than adults with commercial insurance.

Taken together, these results suggest that medical debt contributes to unmet need for treatment across a spectrum of health needs for American adults, regardless of insurance coverage. They also suggest that dental care might be the most sensitive to medical debt, in part because dental care is not always included in health insurance plans-it often requires additional insurance that typically has limited coverage. 

People who put off care at a minimum risk missing prevention opportunities and recommended monitoring. Delaying care can also put people at risk for developing conditions down the road. For instance, poor dental health is linked to heart disease, cognitive decline, and other serious conditions.

Avoiding routine or preventative care can worsen patient health conditions, ultimately making them more costly to address-for patients, insurers, and taxpayers who subsidize much of the medical care in the U.S." 

Catherine Ettman, PhD, senior author, assistant professor, Bloomberg School's Department of Health Policy and Management

According to the paper's authors, recent policy developments, like cuts to insurance coverage in the 2025 Budget Reconciliation Act, may exacerbate medical debt, deferred care, and their downstream economic consequences. "Policies that address affordability and the cascading toll of medical debt are critical to mitigating the health and economic impact of deferred care," says first author Kyle Moon, a PhD candidate in the Bloomberg School's Department of Mental Health. 

The authors note that the study has several limitations. They used self-reported measures of medical financial hardship, which may not fully capture medical debt. Responses about debt levels and deferred care, also self-reported, may suffer from recall bias. 

"Medical Debt and Deferred Care for Physical Health, Mental Health, and Dental Needs Among U.S. Adults" was co-authored by Kyle J. Moon, Nora V. Becker, Katherine E.M. Miller, and Catherine K. Ettman.

This work was supported by the National Institute of Mental Health (1K01MH137318-01A1), National Institute on Drug Abuse (5T32DA007292), and the Agency for Healthcare Research and Quality (K08HS028817).