Business of Medicine

By Steve Barrett
Monday, July 1, 2019

Negative Childhood Experiences Linked to Adult Medical Debt

The odds that a household will carry medical debt and that healthcare costs will exceed 10 percent of its income and all its savings are much greater if an adult in the household had adverse childhood experiences (ACEs), such as abuse or neglect, according to a study in the American Journal of Preventive Medicine.

Researchers collected data on medical debt and adults’ reports of ACEs from the Panel Study of Income Dynamics and the Panel Study of Income Dynamics Childhood Retrospective Circumstances Study supplement.

The likelihood that a household’s medical costs were more than 10 percent of income was about 2.5 times greater if an adult in the household had experienced three or more ACEs versus none.

The same circumstances made the odds approximately 2.3 times greater that medical costs were more than all a household’s savings or that a household carried medical debt.

Patient-Driven Efficiencies On the Way?

Patients and physicians can scarcely be blamed for thinking governmental and insurer efforts to make medical care efficient and cost-effective have produced, well, mixed results.

Health care’s share of U.S. GDP is now in the neighborhood of 20 percent, after all, and healthcare spending could hit $6 trillion per year by 2027.

However, technology may be bringing about a patient-driven revolution in care, according to an article in The Economist. It cites evidence of patients’ proactive role in streamlining their care and making it more valuable:

  • They get consultations online at their convenience.
  • They monitor their health via smartphone, letting their data inform medical algorithms used by trusted clinicians to enhance care for themselves and others.
  • They use over-the-counter tests to evaluate their gut bacteria, sequence their genomes and perform additional tasks.

‘Apology Laws’ Do Not Reduce Litigation, Study Finds

Designed to minimize the likelihood of medical malpractice claims, “apology laws” that have been enacted in 39 states as well as the District of Columbia do not appear to be having that effect, according to a study by law professors at the University of Alabama and Vanderbilt University.

States have enacted such legislation based on the view that the laws could be a path to healing and dispute resolution, according to the authors of the study published in Stanford Law Review. The laws foster apologies for medical errors by declaring them inadmissible in malpractice trials.

The study reviewed data from malpractice claims from a major malpractice insurer. For surgeons, the laws had no substantial effect on whether a surgeon would face a claim. For other physicians, apology laws were associated with a greater likelihood of facing a lawsuit.

“Our findings indicate that on balance, apology laws increase rather than limit medical malpractice liability risk,” the authors write.