TRADING BANKRUPTCY FOR HEALTH IN THE UNITED STATES: A DISCRETE-CHOICE EXPERIMENT

Purpose:

Healthcare in the United States is expensive and drives nearly two-thirds of national bankruptcy cases.  In discussions of care delivery, however, it is often assumed that, when faced with lethal disease, individuals would opt for cure at almost any cost.  This assumption has never been tested, and knowledge regarding how the American population values a tradeoff between cure and bankruptcy is unknown.

Method:

A discrete-choice experiment was performed with 2359 members of the US general public.  Respondents were asked thirteen questions that required them to value combinations of cure and bankruptcy in the presence of a lethal disease.  600 possible model specifications for preferences were tested and dominant models were averaged.  Sensitivity and subgroup analyses were undertaken to test the robustness of the results.

Result:

When presented with a choice that involves cure for a lethal disease and a risk of bankruptcy, utility for the American public is multiplicative in the probability of cure and the probability of financial risk protection.  Financial risk protection more strongly influences preferences than the cure.  This finding was statistically significant.  No sensitivity or subgroup analysis flipped the relationship between financial risk protection and cure.

Conclusion:

Americans do not follow a cure-at-all-costs rubric.  This chapter provides empirical evidence for how the US population values a tradeoff between getting health and facing bankruptcy; in doing so, it brings the financial burden of healthcare access in the US to the fore.