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J Racial Ethn Health Disparities. 2016 Jun;3(2):381-8. doi: 10.1007/s40615-015-0197-5. Epub 2015 Dec 31.

Differences in Problems Paying Medical Bills between African Americans and Whites from 2007 and 2009: the Underlying Role of Health Status.

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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.
Department of Health Management and Policy, School of Public Health and Social Justice, St. Louis University, Saint Louis, MO, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester, MA, USA.



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.


Great recession; Health status; Medical bill problems; Race/ethnicity

[Indexed for MEDLINE]

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