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Health and Health Care Utilization Effects of Medical Debt Forgiveness
Last registered on April 16, 2021

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
Last updated
April 16, 2021 6:08 PM EDT
Location(s)

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Primary Investigator
Affiliation
Stanford University
Other Primary Investigator(s)
PI Affiliation
Harvard Business School
PI Affiliation
NBER
PI Affiliation
UCLA
Additional Trial Information
Status
On going
Start date
2020-11-09
End date
2021-11-30
Secondary IDs
IRB#20-001700
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. 2021. "Health and Health Care Utilization Effects of Medical Debt Forgiveness ." AEA RCT Registry. April 16. https://doi.org/10.1257/rct.7426-1.0.
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
Not available
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

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