Health and Health Care Utilization Effects of Medical Debt Forgiveness

Study Overview
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Brief Summary
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The goal of this study is to estimate the direct, causal impact of medical debt on health care utilization, mental health, and wellbeing of patients. The investigators will conduct a survey to measure the impact of the debt forgiveness on health care use, mental health, and wellbeing. The survey will be administered to approximately 17,000 subjects of a recent medical financial intervention. In that prior intervention, a non-profit charity, RIP Medical Debt, purchased and abolished medical debt for a randomly selected about 6,000 (out of the 17,000) individuals. In this current protocol, the investigators will administer the survey, and will compare surveyed outcomes of subjects who received and did not receive the intervention.

Detailed Description
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This study will estimate the direct, causal impact of medical debt on health care utilization, mental health, and wellbeing of patients. To do so, the investigators will administer a survey to approximately 17,000 subjects of a recent medical financial intervention. In that intervention, a non-profit charity, RIP Medical Debt, purchased and abolished medical debt for a randomly selected about 6,000 (out of the 17,000) study subjects. In this current protocol, the investigators will compare surveyed outcomes of subjects who received and did not receive the medical debt abolishment intervention. Because debt abolishment was randomized, comparing surveyed outcomes of treated and control subjects in the cross-section will allow the study to estimate the causal impact of the medical debt abolishment. The survey will measure the effects of medical debt on three sets of outcomes: (i) health care utilization, as measured by medical care visits, prescription drug utilization and adherence, and unmet need for medical care; (ii) mental health, as measured by validated screens for depression and anxiety; and (iii) subjective wellbeing, as measured by self-reported health, forgone consumption, and financial strain. This study would be the first to provide a direct, causal connection between the rising personal debt associated with U.S. health care and the health outcomes of its recipients.

Official Title
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Health and Health Care Utilization Effects of Medical Debt Forgiveness

Conditions
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Health Care Utilization, Depression, Anxiety, Subjective Wellbeing

Intervention / Treatment
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* Other: Medical debt forgiveness


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals ages 18 and over who owed medical debt to FFAM, a debt collections agency Exclusion Criteria: Excluded individuals who owed less than $500 in medical debt to FFAM Excluded individuals with missing social security numbers

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Treatment<br>Subjects in this treatment group had their medical debt forgiven by a non-profit charity, RIP Medical Debt. This protocol will administer a survey to measure subjects' health care utilization, mental health, and subjective well-being. | Other: Medical debt forgiveness<br>* A non-profit charity, RIP Medical Debt, bought and retired medical debt for individuals that were assigned to the treatment group.<br>|
| Control<br>No intervention was given to subjects in this control group. This protocol will administer a survey to measure subjects' health care utilization, mental health, and subjective well-being. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 8-item Patient Health Questionnaire (PHQ-8) Depression Scale | Scores on the 8-item Patient Health Questionnaire depression scale range from 0 to 24, with higher scores indicating greater severity of depression. | An average of 12 months after the intervention. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Received Needed Health Care | Binary response to: If you needed medical care in the last 12 months, did you get ALL the medical care you needed? (Health Care Utilization domain) | An average of 12 months after the intervention. | 
| Received Needed Rx | Binary response to: If you needed prescription medications in the last 12 months, did you get all the prescription medications you needed? (Health Care Utilization domain) | An average of 12 months after the intervention. | 
| 7-item Generalized Anxiety Disorder (GAD7) Scale | Scores on the 7-item Generalized Anxiety Disorder Scale range from 0 to 21, with higher scores indicating greater severity of anxiety (Mental Health Domain). | An average of 12 months after the intervention. | 
| Stress | Binary response to: Stress means a situation in which a person feels tense, restless, nervous or anxious or is unable to sleep at night because his/her mind is troubled all the time. Do you feel this kind of stress these days? (Mental Health Domain) | An average of 12 months after the intervention. | 
| General Health | Response to: In general, would you say your health is: Excellent, Very Good, Good, Fair, or Poor? (General Health Domain) | An average of 12 months after the intervention. | 
| Happiness | Response to: Taken all together, how would you say things are these days - would you say that you are Very Happy, Pretty Happy, or Not Too Happy? (Subjective Wellbeing Domain) | An average of 12 months after the intervention. | 
| Problems paying other bills | Response to: Besides medical bills, have you had problems paying other types of bills in the past 12 months? (Financial Stress Domain) | An average of 12 months after the intervention. | 
| Changes in spending due to medical debt | Indexed response to: As a result of medical bills have you cut back on spending in the past 12 months on i) basic necessities (like food, heat or housing, or other basic household items), ii) Big-ticket items (like cars, furniture, or appliances); iii) business investments? (Financial Stress Domain) | An average of 12 months after the intervention. | 
| Changes in borrowing due to medical debt | Indexed response to: As a result of medical bills, in the past 12 months, have you i) Increased your credit card debt, or charge card debt? ii) Borrowed money from a payday lender?; iii) Borrowed from friends and family?; iv) Used up all or most of your savings?; v) Increased debt on other lines of credit? (Financial Stress Domain) | An average of 12 months after the intervention. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Care Utilization, Mental Health, Depression, Anxiety, Subjective Wellbeing, Medical Debt