title: Differences in Problems Paying Medical Bills between African Americans and Whites from 2007 and 2009: the Underlying Role of Health Status.
abstract: Although the proportion of people reporting problems paying medical bills has declined in the aftermath of the Great Recession, it is unclear if this decline has been caused by self-rationing of care, particularly among disadvantaged groups. We examined African American-White differences in problems paying medical bills prevalence along with factors which may account for observed differences.
  
  
  
  We used cross-sectional data from 2007 (N = 13,064) and 2010 (N = 11,873) waves of the nationally representative, Health Tracking Household Survey. Logistic regression analyses, accounting for complex survey design and weights, were performed to compute population-based estimates.
  
  
  
  Overall, the prevalence of problems paying medical bills was 18.3 % in 2007 and 19.8 % in 2010. African Americans more frequently reported having problems paying medical bills than Whites. Among African Americans, problems paying medical bills decreased from 30 % in 2007 to 25 % in 2010, which was largely explained by fewer problems reported by those in poor/fair health. Problems paying medical bills significantly declined from 44 % in 2007 to 33 % in 2010 for African Americans in poor/fair health, but remained almost constant for those in good health and very good/excellent health.
  
  
  
  Our findings suggest that African Americans in poor health may be rationing or forgoing necessary care as a result of the recession, which could increase existing health disparities and future health spending. Efforts to reduce racial/ethnic disparities may depend on the extent to which the lingering effects of the Great Recession are mitigated.
authors.affiliation: Department of Health Policy and Management, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612-3805, USA. jwiltshi@health.usf.edu.
authors.forename: Jacqueline C
authors.initials: JC
authors.lastname: Wiltshire
authors.affiliation: Department of Health Management and Policy, School of Public Health and Social Justice, St. Louis University, Saint Louis, MO, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Elder
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D003430:Cross-Sectional Studies; D005382:Financing, Personal; D017048:Health Care Costs; D006297:Health Services Accessibility; D006304:Health Status; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D044469:Racial Groups; D014481:United States; D044465:White People
keywords: Great recession; Health status; Medical bill problems; Race/ethnicity