title: Demographic and service-use profiles of individuals using the CarePayment program for hospital-related medical debt: results from a nationwide survey of guarantors.
abstract: Many Americans find themselves with problems paying medical bills, and medical debt can lead to numerous negative financial, social and access to healthcare outcomes. One potential market-based solution to these challenges is to provide financing options that have patient-friendly terms while complying with increasingly complex federal lending regulations. CarePayment (CP) is one entity that provides zero interest financing to individuals from participating medical facilities. An independent, initial outcome study was undertaken to understand the demographic and medical debt-related outcomes of CP users. This information is integral to understanding whether and how this program can ameliorate the negative consequences of medical debt.
  
  
  
  A nationwide telephone survey was conducted with a random sample of 8122 guarantors who were paying off CarePayment debt as of January 1, 2015. Respondents were asked about their demographic characteristics as well as self-report of negative outcomes typically associated with medical debt. Analyses included descriptive statistics along with logistic regression models comparing first-time CP users and those with higher amounts of CP debt to others.
  
  
  
  The most commonly reported financial challenge related to medical bills was problems paying or being unable to pay medical bills (59.5 %). The most commonly reported access-to-care challenges were skipping a medical test or treatment recommended by a doctor (32.9 %) and having a medical problem but not going to the doctor/clinic (30.3 %). Comparisons between first-time and repeat CP users suggest that first-time users were significantly more likely to report several negative outcomes and those with both CP and non-CP debt were significantly more likely to report nearly all of the undesirable financial and access outcomes that were assessed compared to those with only CP debt.
  
  
  
  The results suggest that CP use, especially repeat CP use, may be associated with a reduction in many negative outcomes of medical debt. In addition, while we found that individuals with only CP debt fared better than those with both CP debt and other medical debt, 60 % of our sample had more than one source of medical debt. This suggests that the beneficial impact of CP could be increased by expanding access to the program.
authors.affiliation: University of Delaware, 017 Carpenter Sports Building, Newark, 19716, DE, USA. LLessard@udel.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Lessard
authors.affiliation: J. Solomon Consulting, LLC, Mountain View, CA, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Solomon
mesh_terms: D000328:Adult; D005260:Female; D005382:Financing, Personal / Q000379:methods / Q000706:statistics & numerical data*; D017722:Hospital Charges; D006801:Humans; D016015:Logistic Models; D008297:Male; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States
keywords: Debt; Hospital financing; Medical bills; Patient credit and financing