Effects of a Patient-Friendly Medical Debt Financing Program on Access to Care and Social Outcomes

Laura Lessard, PhD, MPH, Julie Solomon, PhD




Objectives: To evaluate whether using a patient-friendly payment plan (CarePayment, CP) to finance hospital-acquired debt is associated with reductions in negative access-to-care and social outcomes typically associated with medical debt.


Methods: We compared a nationally representative sample of guarantors actively paying off CP debt (n=1,000) to comparable participants in The Commonwealth Fund 2014 Biennial Health Insurance Survey (n=1,145). We calculated the odds of reporting each outcome, adjusting for household income and total amount of debt.


Results: Compared to others with medical debt, CP guarantors were less likely to report not filling a prescription due to cost; skipping or avoiding needed medical tests and care due to cost; having a medical problem but not going to a doctor/clinic; being unable to pay for household necessities; and delaying education or career plans because of medical bills. CP guarantors were significantly more likely to report skipping preventive care screening due to cost.


Discussion: Our study provides preliminary evidence that a 0% APR line of credit, such as that offered by CP, can result in reductions in many of the negative access-to-care and social outcomes typically associated with medical debt and with negative long-term health effects. This finding is consistent with our previous research comparing outcomes among first-time CP users to those among repeat users, which demonstrated better outcomes among the repeat users. It is incumbent on those interested in reducing those negative effects to consider ways in which patients can have access to manageable payment options for medical bills. Policy and practice options could include increasing access to payment options like CP, and exploring how these programs can be used to cover high co-payments associated with prescription drugs.


Conclusion: CP use is associated with a reduction in multiple negative outcomes typically associated with medical debt. Programs like CP, in combination with other public health policy and practice solutions, have the potential to help patients successfully manage their medical debt, and in turn improve key determinants that influence their health.

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