Medical debt continues to shape how and when consumers seek care, and new research suggests its impact is broader and more persistent than many in the industry may assume. A recent study from the Johns Hopkins Bloomberg School of Public Health finds that individuals with medical debt are significantly more likely to delay dental, medical, and mental health care, even when they have insurance, highlighting ongoing challenges for providers and those working to recover unpaid healthcare balances.
The findings reinforce a growing body of evidence that financial strain is not just a collections issue, but a driver of patient behavior that can directly influence health outcomes and future costs.
What the data shows:
- Dental care is most affected:
- 42.3% of individuals with medical debt delayed dental care vs. 17.7% without
- Medical care is also significantly impacted:
- 23% delayed care vs. just 5.3% without debt
- Mental health care follows:
- 14% delayed care vs. 5% without debt
The study, based on the 2023 National Health Interview Survey of nearly 30,000 adults, found that more than 10% of respondents reported medical debt in the past year.
The key takeaway: Medical debt is not just correlated with delayed care; it is strongly associated with it across every category of treatment.
Why dental care stands out
Dental services appear to be the most sensitive to financial pressure, largely because:
- Dental coverage is often limited or separate from medical insurance
- Out-of-pocket costs can be higher and more immediate
- Patients may perceive dental care as more “deferrable” than other services
Even after adjusting for demographics and insurance status, medical debt increased the likelihood of delaying dental care by more than 24 percentage points, the largest jump among all care types.
Insurance doesn’t eliminate the problem
One of the more notable findings is that insurance coverage does not insulate patients from the effects of medical debt:
- Deferred care rates were similar across insured and uninsured populations for dental and mental health services
- Uninsured individuals were more likely to delay medical care, but the broader trend holds across all coverage types
This suggests that affordability challenges persist even within insured populations, particularly as high deductibles and cost-sharing continue to rise.
Why this matters for collections and providers
For organizations working in healthcare collections, the implications are clear:
- Deferred care today can mean higher balances tomorrow due to worsening conditions
- Patient engagement strategies must account for financial stress, not just balance size
- Preventive care gaps may increase long-term recovery complexity
As one of the study’s authors noted, avoiding routine care can ultimately lead to more expensive interventions down the line, increasing costs for patients, providers, and the broader system.
