Prevalence and Correlates of Medical Financial Hardship in the USA

  • K. Robin YabroffEmail author
  • Jingxuan Zhao
  • Xuesong Han
  • Zhiyuan Zheng
Original Research



High patient out-of-pocket (OOP) spending for medical care is associated with medical debt, distress about household finances, and forgoing medical care because of cost in the USA.


To examine the national prevalence of medical financial hardship domains: (1) material conditions from increased OOP expenses (e.g., medical debt), (2) psychological responses (e.g., distress), and (3) coping behaviors (e.g., forgoing care); and factors associated with financial hardship.

Design and Participants

We identified adults aged 18–64 years (N = 68,828) and ≥ 65 years (N = 24,614) from the 2015–2017 National Health Interview Survey. Multivariable analyses of nationally representative cross-sectional survey data were stratified by age group, 18–64 years and ≥ 65 years.

Main Measures

Prevalence of material, psychological, and behavioral hardship and hardship intensity.

Key Results

Approximately 137.1 million (95% CI 132.7–141.5) adults reported any medical financial hardship in the past year. Hardship is more common for material, psychological and behavioral domains in adults aged 18–64 years (28.9%, 46.9%, and 21.2%, respectively) than in adults aged ≥ 65 years (15.3%, 28.4%, and 12.7%, respectively; all p < .001). Lower educational attainment and more health conditions were strongly associated with hardship intensity in multivariable analyses in both age groups (p < .001). In the younger group, the uninsured were more likely to report multiple domains of hardship (52.8%), compared to those with some public (26.5%) or private insurance (23.2%) (p < .001). In the older group, individuals with Medicare only were more likely to report hardship in multiple domains (17.1%) compared to those with Medicare and public (12.1%) or Medicare and private coverage (10.1%) (p < .001).


Medical financial hardship is common in the USA, especially in adults aged 18–64 years and those without health insurance coverage. With trends towards higher patient cost-sharing and increasing health care costs, risks of hardship may increase in the future.


out-of-pocket spending access to care medical financial hardship medical debt prescription drug nonadherence health insurance National Health Interview Survey 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5002_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 28.9 KB)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • K. Robin Yabroff
    • 1
    Email author
  • Jingxuan Zhao
    • 1
  • Xuesong Han
    • 1
  • Zhiyuan Zheng
    • 1
  1. 1.Surveillance and Health Services Research ProgramAmerican Cancer SocietyAtlantaUSA

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