Tough choices in tough times: debt and medication nonadherence.

Debt is a ubiquitous component of households' financial portfolios. Yet we have scant understanding of how household debt constrains spending on needed health care. Diverse types of debt have different financial properties and recent work has shown that they may have varying implications for spending on needed health care. In this article, we explore the associations between indebtedness and medication nonadherence. First, we consider overall debt levels and then we disaggregate debt into types. We use a population-based sample of 434 residents of southeast Michigan who had been prescribed medications, collected in 2009-2010, the wake of the Great Recession. We find no association between medication nonadherence and total indebtedness. However, when we assess each type of debt separately, we find that having medical or credit card debt is positively associated with medication nonadherence, even net of household income, net worth, and other characteristics. Furthermore, patients with greater amounts of medical or credit card debt are more likely to be nonadherent than those with less. Our results suggest that credit card debt and medical debt may have serious implications for the relative affordability of prescription medications. These associations have been overlooked in past research and deserve further examination.