Trends in charges and association with defaults on medical payments in uninsured Americans: a disproportionate burden in ethnic minorities – a retrospective observational study

• Published in: BMJ open Vol. 12; no. 5; p. e054494
• Main Authors: Linde, Sebastian, Egede, Leonard E
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 25-05-2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Activities of daily living; Adult; Cardiovascular disease; Chargemaster Rates; Charges; Cultural differences; Default; Ethnic and Racial Minorities; Ethnicity; Expenditures; Fees & charges; Health care; Health Policy; Health services utilization; Hispanic or Latino; Hispanic people; Humans; Low income groups; Medical Payment Defaults; Medically Uninsured; Middle Aged; Minority & ethnic groups; Observational studies; Office Visits; Patients; Personal bankruptcy; Prices; Race; Racial Disparities; Retrospective Studies; Structural Inequity; Structural Racism; Trends; Uninsured; United States; Variables; United States; United States > US; Chargemaster Rates; Structural Inequity; Uninsured; Charges; Structural Racism; Medical Payment Defaults; Racial Disparities
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-054494

ObjectiveTo evaluate whether medical event charges are associated with uninsured patients’ probability of medical payment default and whether there exist racial/ethnic disparity gaps in medical payment defaults.DesignWe use logistic regression models to analyse medical payment defaults. Our adjusted estimates further control for a rich set of patient and medical visit characteristics, region and time fixed effects.SettingUninsured US adult (non-elderly) population from 2002 to 2017.ParticipantsWe use four nationally representative samples of uninsured patients from the Medical Expenditure Panel Survey across office-based (n=39 967), emergency (n=3269), outpatient (n=1739) and inpatient (n=340) events.Primary and secondary outcome measuresPayment default, medical event charges and medical event payments.ResultsRelative to uninsured non-Hispanic white (NHW) patients, uninsured non-Hispanic black (NHB) patients are 142% (p<0.01) more likely to default on medical payments for office-based visits, 27% (p<0.05) more likely to default on emergency department visit payments and 82% (p<0.1) more likely to default on an outpatient visit bill. Hispanic patients are 46% (p<0.01) more likely to default on an office-based visit, but 25% less likely to default on emergency department visit payments than NHW patients. Within our fully adjusted model, we find that racial/ethnic disparities persist for office-based visits. Our results further suggest that the probabilities of payment defaults for office-based, emergency and outpatient visits are all significantly (p<0.01) and positively associated with the medical event charges billed.ConclusionsMedical event charges are found to be broadly associated with payment defaults, and we further note disproportionate payment default disparities among NHB patients.