Research Alert: November 13, 2024

Understanding the Impact of Medical Debt in Rural Communities: Perspectives From Rural Hospital Administrators

Medical debt, or individual debt that incurs due to health care and related costs, is pervasive across the U.S. and is a well-documented burden on access to care and overall well-being. However, less is known about the impact of medical debt on hospitals and patients in the context of rural communities. This policy brief presents findings from key informant interviews with nine administrators representing rural hospitals in seven states (AR, CA, IL, TX, VT, WA, and WV). Using content analysis of interview data, researchers share findings around hospital and community-level implications of medical debt, and policies that may help or hinder this issue.

Key Findings:

• Rural hospital administrators from seven states identified uninsurance and underinsurance, existing community sociodemographics, and emergency room usage as key factors contributing to medical debt.
• Hospital administrators discussed hospital and patient-level consequences of medical debt. At the hospital, these included financial burdens, challenges with insurers, and cutting/shifting services or supports. For patients, this meant an exacerbating impact on everyday life, including delays and difficulty accessing care.
• Hospital administrators offered recommendations for policy changes to improve the financial health of rural residents and hospitals. These highlighted a general need to consider the impact of legislation on rural hospitals to avoid unintended consequences, as well as addressing low Medicaid reimbursement rates and challenges with Medicare Advantage.

Additional Resources of Interest:

• More FORHP-funded research on Healthcare financing
• More information about the University of Minnesota Rural Health Research Center