Health Insurance Status, Medical Debt, and Their Impact on Access to Care in Arizona

Objectives. We examined the impact of health insurance status on medical debt among Arizona residents and the impact of both of these factors on access to care. Methods. We estimated logistic regression models for medical debt (problems paying and currently paying medical bills) and access to care (medical care and medications delayed or missed because of cost or lack of insurance). Results. Insured status did not predict medical debt after control for health status, income, age, and household characteristics. Insured status (adjusted odds ratio [AOR]=0.32), problems paying medical bills (AOR=4.96), and currently paying off medical bills (AOR=3.04) were all independent predictors of delayed medical care, but only problems paying (AOR=6.16) and currently paying (AOR=3.68) medical bills predicted delayed medications. Inconsistent coverage, however, was a strong predictor of problems paying bills, and both of these factors led to delays in medical care and medications. Conclusions. At least in Arizona, health insurance does not protect individuals from medical debt, and medical debt and lack of insurance coverage both predict reduced access to care. These results may represent a troubling message for US health care in general. (Am J Public Health. 2011;101:1437-1443. doi:10.2105/AJPH.2010.300080)