More than 28 percent of the 72 million working-age people in the United
States with chronic illnesses such as depression lived in households that
struggled to pay their medical bills in 2007, according to the results of a
national study released last month. And while the uninsured are particularly
vulnerable, medical-bill problems are also growing among people with insurance
and higher incomes.
The study was done by the Center for Studying Health System Change (HSC), a
Washington, D.C., health policy research group.
The number of chronically ill people struggling with health care costs
showed a "significant increase" from the 21 percent reporting such
problems in the HSC's 2003 survey, according to the report.
Among the approximately 20 million chronically ill working-age adults
living in households with medical-bill problems, 25 percent went without
needed care. In addition, 50 percent delayed care, and 56 percent did not fill
a drug prescription that had been written for them.
"The rising prevalence and increasing financial burden of chronic
conditions mean more working-age Americans than ever are forgoing or delaying
medical care because of concerns that they cannot afford treatment,"
said Ha T. Tu, a senior health researcher at the HSC and coauthor of the
The 2007 Health Tracking Household Survey findings were based on a
nationally representative survey of 4,300 working-age adults. The data were
extrapolated for population estimates.
The survey also found that the overall prevalence of chronic conditions
increased between 2003 and 2007. About 34 percent of working-age survey
respondents in 2003 reported at least one chronic illness, while 39 percent of
them, or an estimated 72 million people, had conditions such as diabetes,
asthma, or depression in 2007.
Among uninsured people with chronic illnesses, 62 percent, or an estimated
5.7 million people, were in families that were unable to pay medical bills.
The survey found that 38 percent of such people decided to forgo needed care,
while 65 percent delayed care and 73 percent did not fill a prescription
because of cost concerns.
Access to clinicians by working-age people with chronic illness also was
identified as a challenge, even among people with insurance. Seventeen percent
of such people with private insurance went without needed care, while 43
percent delayed care and 45 percent did not fill a prescription because of
While rates of access problems remained stable—at high
levels—for the uninsured with medical debt between 2003 and 2007,
unmet-need and delayed-care problems for the privately insured with medical
debt increased significantly. The authors attributed the change to a trend
among employers and insurers in that time to increase patient cost
The costs of treating chronic illness appeared to be increasingly borne by
the public. In 2007 about 20 percent of working-age people with chronic
conditions had public insurance, primarily Medicaid and Medicare, compared
with 17 percent in 2003. The period saw commensurate declines in private
coverage of people with chronic illness. The result was a "relatively
stable" 13 percent rate of uninsurance among working-age people with
HSC survey findings are posted at<www.hschange.org/CONTENT/1049>.▪