Medical debt – that is, debt incurred because of health care costs and related expenditures – impacts 40% of adults in the U.S., amounting to approximately 100 million people. Medical debt has multiple deleterious effects, including creating barriers to accessing additional health care, stress, and difficulty managing finances for other basic needs, such as housing and nutrition. Further, high rates of medical debt in a community can negatively impact health care providers' and facilities' financial stability. Despite the widespread impact of medical debt on the U.S. population, relatively little is known about rural/urban differences in medical debt. Of the research that does exist, there is an indication that rural residents experience greater rates of medical debt, as evidenced by higher rates of contact by debt collection agencies. Even less is known about differences in medical debt among rural residents by geography (e.g., region, state, county) and by socio-demographic characteristics (e.g., age, race, ethnicity, gender, health status). This information is critical to inform rural health policy, especially as rural residents experience poorer health and rural health care facilities navigate financially tenuous situations. Further, additional information on rural medical debt is needed to inform widespread policies such as Medicaid expansion, which has been shown to reduce medical debt. This project will address the aforementioned gaps in the research.

Publications

• Health Care Affordability and Medical Debt: Differences by Rurality, Region, and Socio-Demographic Characteristics
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 09/2024
  This policy brief examines rural/urban differences in rates of health care (un)affordability, as well as among rural residents by key socio-demographic characteristics.
• Medical Debt in Collections Among Counties by Rural-Urban Location and Racial-Ethnic Composition
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 11/2024
  This policy brief examines the differences in the proportion of people with medical debt in collections and median amount of medical debt by rural-urban location. The brief also examines additional differences within rural and urban communities of color.
• Understanding the Impact of Medical Debt in Rural Communities: Perspectives From Rural Hospital Administrators
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 11/2024
  This policy brief presents findings from key informant interviews with nine administrators representing rural hospitals in seven states. 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.