Robert Fromberg
Editor-in-Chief, HFMA
Earlier this week, I posted an entry about the importance of research into healthcare issues that are emotional or difficult to quantify, using whimsical attempts to quantify Mona Lisa's expression as a jumping-off point.
The debate that has erupted over the past few days over quantifying the dimensions of the medical-debt problem trumps any attempt at a cute metaphor.
Briefly, here is the situation. A study by Dranove and Millenson found that 17% of bankruptcies are caused by medical debt, contradicting a study by Himmelstein et al. that produced the more dire (and often-cited) finding that up to 54% of bankruptcies are the result of medical debt. The Himmelstein et al. study said middle-class families were quite vulnerable. The Dranove-Millenson study says that those closer to poverty level are at greater risk.
Here is an excerpt of the contentious dialogue in Health Affairs between the two research teams (look under "Web Exclusives").
Himmelstein et al.: "David Dranove and Michael Millenson seem determined to deny that financial fallout from illness pushes middle-class families into bankruptcy....They dismiss families' explanations of their difficulties and blame those ruined by illness for their own problems. However, the data from the bankruptcy courts are undeniable. Bankruptcies affect mainly middle-class, privately insured families, and about half are triggered, at least in part, by illnesses."
Dranove and Millenson: "Our paper denies neither the presence of medical bankruptcies nor their serious impact on families. Rather, we carefully critique the methods [the authors] used to analyze those bankruptcies. They continue to offer only one direct causal measure: namely, that medical bills 'contribute' to 17 percent of personal bankruptcies. The remaining anecdotes and correlations they offer do not constitute systematic empirical research....Thus, it is impossible to determine from the study whether and by how much the expansion of health insurance coverage would reduce the personal bankruptcy rate."
