Nearly 40% of adults who undergo surgery in the United States experience significant financial hardship in the year that follows, according to research published in JAMA Surgery. The findings add another data point to the intensifying conversation around medical debt, underinsurance, and the financial fragility of patients — an issue that directly affects healthcare providers and the ARM industry.
The background: Researchers at the University of Washington analyzed responses from the Medical Expenditure Panel Survey between 2014 and 2021, comparing adults ages 18 to 64 who underwent surgery with a matched control group that did not. Because respondents are surveyed multiple times over two years, the team was able to isolate the impact of surgery on a patient’s financial situation.
Overall, 38% of surgical patients reported experiencing financial hardship after their procedure. The study found that undergoing surgery was associated with a 16% relative increase in financial hardship and an eight-fold increase in annual out-of-pocket spending. Emergency surgeries carried the most severe financial consequences, particularly for privately insured and uninsured patients.
The findings: The most striking takeaway for policymakers and providers is how sharply results varied by insurance type. Medicaid patients saw no increase in financial hardship after surgery, a finding the authors called both unexpected and critical. By contrast, privately insured low-income patients faced some of the highest burdens, second only to uninsured individuals. The authors tied this to the steady growth of deductibles, coinsurance, and other forms of cost-sharing pushed onto consumers.
Emergency surgeries revealed the biggest gaps in protection. Patients cannot prepare financially, secure preauthorization, or set aside savings when surgery is unplanned, making the existing insurance design, especially high-deductible plans, a poor match for real-world medical crises. Lead researchers described emergency care as “the ultimate litmus test for health insurance,” noting that Medicaid passed while private insurance “failed” to prevent financial harm.
For providers, revenue cycle leaders, and collection organizations, the study reinforces a trend already reflected in consumer complaints, legislative proposals, and media coverage: rising underinsurance is accelerating medical debt, even among insured populations. As policymakers weigh changes to Medicaid eligibility and as mainstream outlets continue to spotlight affordability gaps, healthcare organizations should expect continued scrutiny of billing practices, patient financial counseling, charity care policies, and collection strategies.
The bottom line:
