Health and Health Care Utilization Effects of Medical Debt Forgiveness

Last registered on July 26, 2024

Pre-Trial

Trial Information

General Information

Title
Health and Health Care Utilization Effects of Medical Debt Forgiveness
RCT ID
AEARCTR-0007426
Initial registration date
April 16, 2021

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
April 16, 2021, 6:08 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
July 26, 2024, 9:29 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Region

Primary Investigator

Affiliation
Stanford University

Other Primary Investigator(s)

PI Affiliation
UCLA
PI Affiliation
NBER
PI Affiliation
Harvard Business School

Additional Trial Information

Status
Completed
Start date
2020-11-09
End date
2021-11-30
Secondary IDs
IRB#20-001700
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
This study will estimate the direct, causal impact of medical debt on health care utilization, mental health, and wellbeing of patients. To do so, the investigators will administer a survey to approximately 17,000 subjects of a recent medical financial intervention. In that intervention, a non-profit charity, RIP Medical Debt, purchased and abolished medical debt for a randomly selected about 6,000 (out of the 17,000) study subjects. In this current protocol, the investigators will compare surveyed outcomes of subjects who received and did not receive the medical debt abolishment intervention. Because debt abolishment was randomized, comparing surveyed outcomes of treated and control subjects in the cross-section will allow the study to estimate the causal impact of the medical debt abolishment. The survey will measure the effects of medical debt on three sets of outcomes: (i) health care utilization, as measured by medical care visits, prescription drug utilization and adherence, and unmet need for medical care; (ii) mental health, as measured by validated screens for depression and anxiety; and (iii) subjective wellbeing, as measured by self-reported health, forgone consumption, and financial strain. This study would be the first to provide a direct, causal connection between the rising personal debt associated with U.S. health care and the health outcomes of its recipients.
External Link(s)

Registration Citation

Citation
Kluender, Raymond et al. 2024. "Health and Health Care Utilization Effects of Medical Debt Forgiveness ." AEA RCT Registry. July 26. https://doi.org/10.1257/rct.7426-2.1
Experimental Details

Interventions

Intervention(s)
A non-profit charity, RIP Medical Debt, bought and retired medical debt for individuals that were randomly assigned to the treatment group.
Intervention Start Date
2020-11-09
Intervention End Date
2021-11-30

Primary Outcomes

Primary Outcomes (end points)
8-item Patient Health Questionnaire (PHQ-8) Depression Scale
Primary Outcomes (explanation)
Scores on the 8-item Patient Health Questionnaire depression scale range from 0 to 24, with higher scores indicating greater severity of depression.

Secondary Outcomes

Secondary Outcomes (end points)
1. Received Needed Health Care
2. Received Needed Rx
3. 7-item Generalized Anxiety Disorder (GAD7) Scale
4. Stress
5. General Health
6. Happiness
7. Problems paying other bills
8. Changes in spending due to medical debt
9. Changes in borrowing due to medical debt
Secondary Outcomes (explanation)
See pre-analysis plan for details

Experimental Design

Experimental Design
Group: Treatment

Subjects in this "treatment" group had their medical debt forgiven by a non-profit charity, RIP Medical Debt. This protocol will administer a survey to measure subjects' health care utilization, mental health, and subjective well-being.

Group: Control

No intervention was given to subjects in this "control" group. This protocol will administer a survey to measure subjects' health care utilization, mental health, and subjective well-being.
Experimental Design Details
Randomization Method
Randomization was conducted by computer.
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
Treatment was not clustered
Sample size: planned number of observations
17,000 (anticipated)
Sample size (or number of clusters) by treatment arms
Out of 17,000 individuals, 6,000 were treated and 11,000 were controls.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Assuming a survey response rate of 20%, the MDE for the binary depression indicator (based on PHQ 8) is 0.05 percentage points or 13.9% of the 35.7% control group mean (control group mean calculated using data from the pilot).
IRB

Institutional Review Boards (IRBs)

IRB Name
Stanford University Administrative Panel on Human Subjects in Non-Medical Research
IRB Approval Date
2020-09-11
IRB Approval Number
57138
Analysis Plan

Analysis Plan Documents

Pre-analysis Plan

MD5: 3b638259f663e920653db3ad597c6384

SHA1: 272aa1d4487a3b07c52afd59d1300390d6c3b5c2

Uploaded At: April 15, 2021

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials