Over one-quarter of adults in the U.S. experience burdensome health cost

Overall, 17.4% of adults experienced cost burdens and 9.9% experienced catastrophic cost burdens (CCBs) over a four-year period from 2018–2022, according to a study published online Dec. 22 in JAMA Internal Medicine.

Adam Gaffney, M.D., M.P.H., from Harvard Medical School in Boston, and colleagues conducted a cohort study to assess burdensome out-of-pocket (OOP) health care costs and care foregone due to cost over a four-year period. Data were analyzed for 12,645 respondents (74.6% aged 18 years or older) to the four-year longitudinal Medical Expenditure Panel Surveys. Cost burden was defined as individual annual OOP medical spending greater than 10% of family income; CCB was defined as OOP spending greater than 40% of postsubsistence income.

The researchers found that 6.5% of adults experienced cost burdens and 3.5% had CCBs during year one; 17.4% and 9.9%, respectively, experienced these outcomes at least once over four years. Overall, 24.7% and 11.2% of U.S. individuals lived in families experiencing cost burdens over four years and CCBs, respectively.

Among adults, 26.7% experienced foregone care due to cost or cost burden over four years. Associations with higher cost burden were seen for lower income, having no insurance, hospitalizations, and chronic disease. In one to four years before death, 53.2% of decedents experienced cost burdens.

“High medical costs don’t just devastate finances, they force people to skip care, which often further worsens their health,” Gaffney said in a statement. “It’s time America joined other nations and implemented national health insurance.”

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