Credit card debt may not make you sick, but new evidence
suggests that it could slow your recovery -- or worse.
A study conducted by sociologists at the University of Michigan
found that people who are ill and do not seek treatment because of
the cost are more likely to have credit card debt than any other
form of debt.
More than 64 percent of those who were ill but had not seen a
health care provider because of the cost reported that they were
indebted to credit card companies. In second place: Those who
already shouldered medical debts. Nearly 58 percent of respondents
who were sick and did not seek medical care said they already were
dealing with medically related indebtedness.
"We found that having credit card debt or medical debt was
associated with forgoing medical care, as opposed to having student
loans, housing loans or car loans," said Lucie Kalousova, Ph.D., a
co-author of the study, "
Debt and Forgone Medical Care
," published in the April 2013 Journal of Health and Social
"The odds of forgone medical care for a person with credit card
debt were 1.89 times those of the odds of a person without any
credit card debt, and the likelihood of forgoing care increased
with the magnitude of the credit card debt," she said. "This
remained the case even after we took into account other assets in
the household and income."
The consequences could be dire.
Debt's downward health cycle
To state the obvious, people who forgo or significantly delay the
treatment of illness can slow their recovery or become increasingly
ill as their condition deteriorates. They also could end up paying
much more to regain their health. Their productivity -- and,
consequently, their income -- can be diminished. They also tend to
put more strain on hospital emergency rooms and other public health
"In our article, we call for a more comprehensive understanding
of the concept of financial resources in relation to
health-care-seeking," Kalousova said. "When researchers or policy
makers talk about the amount of money or assets people can use to
take care of their health care needs, they rarely consider the
nature of other expenditures people are responsible for."
She and co-author Sarah A. Burgard, Ph.D., emphasized that they
found no significant association between other forms of debt --
student loans, mortgages, car loans, etc. -- and delays in seeking
treatment for ill health. They believe the differences reside in
the nature of the debts.
"Our data cannot directly speak to why that is the case, until we
can examine how debt portfolios and seeking health care change for
people over time in relation to one another," Kalousova said. "At
the moment, we can only speculate that some debts, sometimes
colloquially thought of as 'good' debts, have traditionally been a
signal of creditworthiness, and probably do not influence decisions
to consume needed medical care."
Those "good debts" can include student, housing and car loans,
which tend to carry relatively low interest rates, lengthy payback
terms and a certain degree of social acceptance. These loans can
improve career achievement and generally lead to enhanced standards
Credit card and other 'bad debts' tend to carry higher interest
rates and are borne during times of personal distress, the
"Other debts generally thought of as 'bad' debts, such as credit
card debt, may have been less planned for some people and may
quickly accumulate beyond their ability to repay," Kalousova said.
"Holders of such debts may be under more pressure to repay them to
avoid interest and stress, and they may forgo medical care to save
money under this kind of pressure, even if they really need
The sociologists' study examined responses in late 2009 from 914
residents of southeastern Michigan and included adjustments for the
socioeconomic and medically related characteristics of those
studied. The researchers said they believed the results were
reasonably representative of Americans as a whole. "We have no
reason to believe that this relationship would only play out in
Southeast Michigan and not in other parts of the country,"
Builds on prior studies
Previous studies have found that people who delayed going to the
doctor when ill had lower household incomes and were less likely to
have health insurance than other people, which is not surprising.
Other studies reported significant links between credit card debt
and smoking, excessive alcohol use and other risky health
In addition, the U.S. Centers for Disease Control reported that
about 11 percent of working-age Americans declined to see a doctor
in 2010 because of the cost, even though those people were ill at
The University of Michigan researchers decided to dig deeper --
exploring for specific links between forgone medical care and
financial distress. In the end, they found the strong association
between delayed medical care and credit card debt, and much weaker
associations between forgone care and most other forms of debt.
The 64 percent of respondents who carried credit card debt and
needed but had not sought medical care owed an average of $8,541 to
credit card companies, the study reported.
"The results were very clear ...," the report concludes, "credit
card debt and medical debt were strongly and positively associated
with having forgone care in the past 12 months."
Impact on health not understood
Importantly, the study's authors did not issue a blanket
condemnation of credit card balances or any other form of debt.
"Taking on debt has become a critical part of how many
individuals achieve valued social statuses, such as becoming a
homeowner or a college graduate, as well as how they may obtain
material goods and services, including health care, when the costs
exceed their immediate financial resources," the study said. "Debt
is a fundamental part of financial lives in the United States, but
we have only a very limited understanding of what debt means for
"Debt become problematic when it exceeds the holder's ability to
service it and causes difficult spending decisions" such as seeking
medical care when necessary, the study said.
Marshall B. Kapp, director of Florida State University's Center
for Innovative Collaboration in Medicine and Law, said that all of
this will come into play as the federal Affordable Care Act, also
known as Obamacare, increasingly takes hold and more people --
including those with credit card debt -- gain access to health
"The Affordable Care Act, at least theoretically, should provide
a stronger and more socially accepted safety net for even heavily
indebted people who avoid seeking medical care today because they
lack good health insurance," Kapp said. "The theory is that
between federal subsidies for families making up to 400 percent of
the federal poverty line and the proliferation of insurance choices
through the exchanges, everyone can, and is indeed required to, get
"It seems to me that this is exactly the kind of situation that
the ACA needs to address if it hopes to be considered a success,"
Kalousova agreed, though she also expressed a wait-and-see
"Our study is only the first step in this direction and more
comprehensive research is needed to address these questions," she
"However, particularly in light of the current health care
debate, it is important to stay aware that even comprehensive
health insurance may not always help people who have high
expenditures in other areas, such as those who have accumulated
high levels of debt," she added.
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