Davenport says financial stressors may not always rise to the level of bankruptcy, but consumers face myriad other financial problems. They may spend down their retirement savings, or their credit scores are affected. With credit problems, the ability to obtain other assistance, such as a student loan, would be impacted. Davenport agrees with Woolhandler that those with debt may further exacerbate their medical problems because of the high cost of care, including medications, which can lead to splitting pills or simply not filling a prescription and going without the care they need. This is not just an issue of how many are forced into bankruptcy, Davenport remarks, but how many have trouble paying medical bills that create further hardship, reduce the level of care, skimp on prescriptions and affect the consumers who are most vulnerable, including older persons or those with a chronic illness.

The demographics of medical debt seem to affect the middle-aged. From the data gathered for the bankruptcy study, Woolhandler and her associates determined that the average age of the person filing bankruptcy was 45, and a majority were women. Younger persons did not appear to have had a chance to accumulate debt, and seniors are less likely to file bankruptcy, perhaps because of the safety net of Medicare and Social Security. The rate of bankruptcy filing is associated with family size, Woolhandler said. "That suggests problems with the social safety net. Those with larger families are more likely to face crises than a single person."

Davenport suggests another way to look at the medical debt situation is to review the work researcher Karen Pollitz and colleagues did with comparisons of policies in California and Massachusetts, and how much difference in policies there are for people who have a particular condition, and the out-of-pocket costs some may end up facing. The executive summary of Pollitz's study found that health insurance protection is "highly dependent on the policy purchased. An insured person who becomes seriously ill might have to pay thousands, or tens of thousands, of dollars out-of-pocket for needed care."

For the consumers facing the high out-of-pocket costs, the difference in policy represents "financial catastrophe." The summary concludes: "The affordability of health insurance premiums cannot be considered independently of the adequacy of coverage health insurance provides," as the adequacy of the coverage is key to the range of costs placed upon the consumer.

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