Medical Debt Is Disappearing From Americans’ Credit Reports, Lifting Scores

Noam Levey

KFF Health News

Originally published 2 Nove 23

The share of American consumers with medical debt on their credit reports has declined dramatically over the past year as major credit rating agencies removed small unpaid bills and debts that were less than a year old, according to a new analysis from the nonprofit Urban Institute.

At the same time, millions of Americans have seen their credit scores improve, making it easier for many to get a job, rent an apartment, or get a car.

“This is a very significant change,” said Breno Braga, an economist at the Urban Institute and a co-author of the study. “It affects a lot of people.”

For years, medical debt has depressed credit scores, undermining the financial security of tens of millions of patients and their families.

Under mounting pressure from patient advocates and government regulators, the three major credit agencies over the last two years have taken a series of steps to remove some medical debts from credit reports, including unpaid medical bills under $500.

The changes appear to be having an impact. As of August, just 5% of adults with a credit report had a medical debt on their report, down from almost 14% two years earlier.

Urban Institute researchers also found that Americans with a medical debt on their credit report in August 2022 saw their VantageScore credit score improve over the next year from an average of 585 to an average of 615.

The info is here.

Here is my summary:

The article discusses a study conducted by the Urban Institute, focusing on the impact of removing medical debt from credit reports. The study reveals that eliminating medical debt from credit reports can significantly improve individuals' credit scores and financial well-being. The research found that once medical debts were removed, more than two-thirds of affected individuals experienced an increase in their credit scores, with an average rise of 16 points. This is particularly crucial as medical debt is often incurred unexpectedly, and its presence on credit reports can lead to long-lasting financial consequences for individuals, affecting their ability to secure loans or access favorable interest rates.

Furthermore, the study suggests that removing medical debt from credit reports can contribute to reducing racial and ethnic disparities in credit scores. It highlights that individuals from communities of color are disproportionately affected by medical debt and its consequences on creditworthiness. By addressing this issue, there is an opportunity to promote greater financial equity and inclusivity. The findings underscore the potential benefits of policy interventions or industry practices aimed at mitigating the adverse impact of medical debt on individuals' credit histories, thereby fostering a more equitable financial landscape.

Compassion Fatigue as a Self-Fulfilling Prophecy: Believing Compassion Is Limited Increases Fatigue and Decreases Compassion

Gainsburg, I., & Lee Cunningham, J. (2023). 

Psychological science, 34(11), 1206–1219.

https://doi.org/10.1177/09567976231194537

Abstract

People's compassion responses often weaken with repeated exposure to suffering, a phenomenon known as compassion fatigue. Why is it so difficult to continue feeling compassion in response to others' suffering? We propose that people's limited-compassion mindsets-beliefs about compassion as a limited resource and a fatiguing experience-can result in a self-fulfilling prophecy that reinforces compassion fatigue. Across four studies of adults sampled from university students and online participant pools in the United States, we show that there is variability in people's compassion mindsets, that these mindsets can be changed with convincing information, and that limited-compassion mindsets predict lower feelings of compassion, lower-quality social support, and more fatigue. This contributes to our understanding of factors that underlie compassion fatigue and supports the broader idea that people's beliefs about the nature of emotions affect how emotions are experienced. Together, this research contributes to developing a strategy for increasing people's capacity to feel compassion and their social support.

Here is an excerpt:

Compassion and Its (Potential) Limits

Compassion is the feeling of concern for others’ suffering and the accompanying motivation to help (Goetz et al., 2010). Like other psychological capacities (e.g., short-term memory; Cowan, 2016), there may be limits to people’s compassion capacities. Relevant to the present research, compassion can weaken in response to prolonged, repeated exposure to suffering (i.e., compassion fatigue; Figley, 1995). Compassion fatigue was conceptualized as an occupational hazard among healthcare professionals, and it is defined as “a healthcare practitioner’s diminished capacity to care as a consequence of repeated exposure to the suffering of patients, and from the knowledge of their patient’s traumatic experiences” (Cavanagh et al., 2020, p. 640) and “a state of exhaustion . . . as a result of prolonged exposure to compassion stress” (Figley, 1995, p. 253).

Although compassion fatigue often stems from actively caring for patients, the mere knowledge of or exposure to patients’ suffering can also cause compassion fatigue (Cavanagh et al., 2020). Thus, media scholars also theorized about compassion fatigue following people’s repeated exposure to news media depicting the suffering of distant others disconnected from the self (Kinnick et al., 1996; Moeller, 1999). Supporting this idea, one experimental, lab-based study showed that participants who saw many (vs. few) compassion-inducing videos exhibited less empathy and reduced intent to help people in need during an unrelated task (Süssenbach, 2018). Although this context is different from health care, research in both contexts demonstrates the core elements of compassion fatigue: repeated exposure to suffering reduces subsequent compassion.

Why Mindsets May Influence Compassion

Although the capacity to feel sustained compassion in response to ongoing suffering may be limited, it is also possible that believing compassion is limited (i.e., having a limited mindset) contributes to compassion fatigue. In their review of limited willpower mindsets, Bernecker and Job (2019) explain that people with limited mindsets view their willpower as a “limited resource that gets depleted whenever used,” whereas those with nonlimited mindsets “reject this view and rather believe that using their willpower can even activate their mental stamina.” In the present research, people with limited mindsets may believe that feeling compassion depletes their emotional resources, requiring rest and recovery; people with nonlimited mindsets may disagree, and potentially view an initial experience of compassion as emotionally energizing, increasing their ability to feel compassion for others.

Critically, research suggests that limited mindsets can produce mindset-consistent experiences: Job and colleagues (2010) showed variability in limited versus nonlimited mindsets, the malleability of mindsets in response to information, and effects of limited mindsets on self-control and mental fatigue. Subsequent research suggests that these effects may be due to mindsets influencing people’s task-specific expectations and interpretations of mental experiences when exerting willpower (Chow et al., 2015; Francis & Job, 2018). Similarly, we propose that limited mindsets for compassion increases compassion fatigue via increased expectations of compassion fatigue in contexts eliciting ongoing compassion.

Older people are perceived as more moral than younger people: data from seven culturally diverse countries

Piotr Sorokowski, et al. (2023)

Ethics & Behavior,

DOI: 10.1080/10508422.2023.2248327

Abstract

Given the adage “older and wiser,” it seems justified to assume that older people may be stereotyped as more moral than younger people. We aimed to study whether assessments of a person’s morality differ depending on their age. We asked 661 individuals from seven societies (Australians, Britons, Burusho of Pakistan, Canadians, Dani of Papua, New Zealanders, and Poles) whether younger (~20-year-old), middle-aged (~40-year-old), or older (~60-year-old) people were more likely to behave morally and have a sense of right and wrong. We observed that older people were perceived as more moral than younger people. The effect was particularly salient when comparing 20-year-olds to either 40- or 60-year-olds and was culturally universal, as we found it in both WEIRD (i.e. Western, Educated, Industrialized, Rich, Democratic) and non-WEIRD societies.

A pdf of the research is here.

Here is my summary:

The researchers found that older people were rated as more moral than younger people, and this effect was particularly strong when comparing 20-year-olds to either 40- or 60-year-olds. The effect was also consistent across cultures, suggesting that it is a universal phenomenon.

The researchers suggest that there are a few possible explanations for this finding. One possibility is that older people are simply seen as having more life experience and wisdom, which are both associated with morality. Another possibility is that older people are more likely to conform to social norms, which are often seen as being moral. Finally, it is also possible that people simply have a positive bias towards older people, which leads them to perceive them as being more moral.

Whatever the explanation, the finding that older people are perceived as more moral than younger people has a number of implications. For example, it suggests that older people may be more likely to be trusted and respected, and they may also be more likely to be seen as leaders. Additionally, the finding suggests that ageism may be a form of prejudice, as it involves making negative assumptions about people based on their age.

Clinical documentation of patient identities in the electronic health record: Ethical principles to consider

Decker, S. E., et al. (2023). 

Psychological Services.

Advance online publication.

https://doi.org/10.1037/ser0000816

Abstract

The American Psychological Association’s multicultural guidelines encourage psychologists to use language sensitive to the lived experiences of the individuals they serve. In organized care settings, psychologists have important decisions to make about the language they use in the electronic health record (EHR), which may be accessible to both the patient and other health care providers. Language about patient identities (including but not limited to race, ethnicity, gender, and sexual orientation) is especially important, but little guidance exists for psychologists on how and when to document these identities in the EHR. Moreover, organizational mandates, patient preferences, fluid identities, and shifting language may suggest different documentation approaches, posing ethical dilemmas for psychologists to navigate. In this article, we review the purposes of documentation in organized care settings, review how each of the five American Psychological Association Code of Ethics’ General Principles relates to identity language in EHR documentation, and propose a set of questions for psychologists to ask themselves and their patients when making choices about documenting identity variables in the EHR.

Impact Statement

Psychologists in organized care settings may face ethical dilemmas about what language to use when documenting patient identities (race, ethnicity, gender, sexual orientation, and so on) in the electronic health record. This article provides a framework for considering how to navigate these decisions based on the American Psychological Association Code of Ethics’ five General Principles. To guide psychologists in decision making, questions to ask self and patient are included, as well as suggestions for further study.

Here is my summary:

The authors emphasize the lack of clear guidelines for psychologists on how and when to document these identity variables in EHRs. They acknowledge the complexities arising from organizational mandates, patient preferences, fluid identities, and evolving language, which can lead to ethical dilemmas for psychologists.

To address these challenges, the article proposes a framework based on the five General Principles of the American Psychological Association (APA) Code of Ethics:

1. Fidelity and Responsibility: Psychologists must prioritize patient welfare and act in their best interests. This includes respecting their privacy and self-determination when documenting identity variables.
2. Competence: Psychologists should possess the necessary knowledge and skills to accurately and sensitively document patient identities. This may involve ongoing training and staying abreast of evolving language and cultural norms.
3. Integrity: Psychologists must maintain ethical standards and avoid misrepresenting or misusing patient identity information. This includes being transparent about the purposes of documentation and seeking patient consent when appropriate.
4. Respect for Human Rights and Dignity: Psychologists must respect the inherent dignity and worth of all individuals, regardless of their identity. This includes avoiding discriminatory or stigmatizing language in EHR documentation.
5. Social Justice and Public Interest: Psychologists should contribute to the promotion of social justice and the elimination of discrimination. This includes being mindful of how identity documentation can impact patients' access to care and their overall well-being.

To aid psychologists in making informed decisions about identity documentation, the authors propose a set of questions to consider:

1. What is the purpose of documenting this identity variable?
2. Is this information necessary for providing appropriate care or fulfilling legal/regulatory requirements?
3. How will this information be used?
4. What are the potential risks and benefits of documenting this information?
5. What are the patient's preferences regarding the documentation of their identity?

By carefully considering these questions, psychologists can make ethically sound decisions that protect patient privacy and promote their well-being.

Ethical Reasoning vs. Empathic Bias: A False Dichotomy?

Law, K. F., Amormino, P. et al.

(2023, September 5).

https://doi.org/10.31234/osf.io/2rt7y

Abstract

Does empathy necessarily impede equity in altruism? Emerging findings from cognitive and affective science suggest that rationality and empathy are mutually compatible, contradicting some earlier, prominent arguments that empathy impedes equitable giving. We propose alternative conceptualizations of relationships among empathy, rationality, and equity, drawing on interdisciplinary advances in altruism research.

Here is my summary: 

This article discusses the relationship between ethical reasoning and empathic bias. Ethical reasoning is the process of using logic and reason to make moral decisions. Empathic bias is the tendency to make moral decisions that are influenced by our emotions and our personal relationships with the people involved.

The article argues that these two concepts are often seen as being in opposition to each other, but that this is a false dichotomy. Both ethical reasoning and empathic bias are important for making moral decisions. Ethical reasoning allows us to think about the broader implications of our decisions, while empathic bias allows us to connect with the individuals who are affected by our decisions.

The article concludes by suggesting that we should strive to use both ethical reasoning and empathic bias in our moral decision-making. By doing so, we can make more informed and compassionate decisions.

This article demonstrates that the Ethical Acculturation Model is not widely known by researchers.  The EAM stresses the professional's ability to integrate their own professional obligations and norms with their personal beliefs, values, and morality. Only through blending these important components can individuals resolve complex ethical/moral dilemmas.

Science and Ethics of “Curing” Misinformation

Freiling, I., Knause, N.M., & Scheufele, D.A.

AMA J Ethics. 2023;25(3):E228-237. 

doi: 10.1001/amajethics.2023.228.

Abstract

A growing chorus of academicians, public health officials, and other science communicators have warned of what they see as an ill-informed public making poor personal or electoral decisions. Misinformation is often seen as an urgent new problem, so some members of these communities have pushed for quick but untested solutions without carefully diagnosing ethical pitfalls of rushed interventions. This article argues that attempts to “cure” public opinion that are inconsistent with best available social science evidence not only leave the scientific community vulnerable to long-term reputational damage but also raise significant ethical questions. It also suggests strategies for communicating science and health information equitably, effectively, and ethically to audiences affected by it without undermining affected audiences’ agency over what to do with it.

My summary:

The authors explore the challenges and ethical considerations surrounding efforts to combat misinformation. The authors argue that using the term "curing" to describe these efforts is problematic, as it suggests that misinformation is a disease that can be eradicated. They argue that this approach is overly simplistic and disregards the complex social and psychological factors that contribute to the spread of misinformation.

The authors identify several ethical concerns with current approaches to combating misinformation, including:

• The potential for censorship and suppression of legitimate dissent.
• The undermining of public trust in science and expertise.
• The creation of echo chambers and further polarization of public opinion.

Instead of trying to "cure" misinformation, the authors propose a more nuanced and ethical approach that focuses on promoting critical thinking, media literacy, and civic engagement. They also emphasize the importance of addressing the underlying social and psychological factors that contribute to the spread of misinformation, such as social isolation, distrust of authority, and a desire for simple explanations.

Health Insurers Have Been Breaking State Laws for Years

Maya Miller and Robin Fields

ProPublic.org

Originally published 16, NOV 23

Here is an excerpt:

State insurance departments are responsible for enforcing these laws, but many are ill-equipped to do so, researchers, consumer advocates and even some regulators say. These agencies oversee all types of insurance, including plans covering cars, homes and people’s health. Yet they employed less people last year than they did a decade ago. Their first priority is making sure plans remain solvent; protecting consumers from unlawful denials often takes a backseat.

“They just honestly don’t have the resources to do the type of auditing that we would need,” said Sara McMenamin, an associate professor of public health at the University of California, San Diego, who has been studying the implementation of state mandates.

Agencies often don’t investigate health insurance denials unless policyholders or their families complain. But denials can arrive at the worst moments of people’s lives, when they have little energy to wrangle with bureaucracy. People with plans purchased on HealthCare.gov appealed less than 1% of the time, one study found.

ProPublica surveyed every state’s insurance agency and identified just 45 enforcement actions since 2018 involving denials that have violated coverage mandates. Regulators sometimes treat consumer complaints as one-offs, forcing an insurer to pay for that individual’s treatment without addressing whether a broader group has faced similar wrongful denials.

When regulators have decided to dig deeper, they’ve found that a single complaint is emblematic of a systemic issue impacting thousands of people.

In 2017, a woman complained to Maine’s insurance regulator, saying her carrier, Aetna, broke state law by incorrectly processing claims and overcharging her for services related to the birth of her child. After being contacted by the state, Aetna acknowledged the mistake and issued a refund.

The info is here.

Here's my take:

The article explores the ethical issues surrounding health insurance denials and the violation of state laws. The investigation reveals a pattern of health insurance companies systematically denying coverage for medically necessary treatments, even when such denials directly contravene state laws designed to protect patients. The unethical practices extend to various states, indicating a systemic problem within the industry. Patients are often left in precarious situations, facing financial burdens and health risks due to the denial of essential medical services, raising questions about the industry's commitment to prioritizing patient well-being over profit margins.

The article underscores the need for increased regulatory scrutiny and enforcement to hold health insurance companies accountable for violating state laws and compromising patient care. It highlights the ethical imperative for insurers to prioritize their fundamental responsibility to provide coverage for necessary medical treatments and adhere to the legal frameworks in place to safeguard patient rights. The investigation sheds light on the intersection of profit motives and ethical considerations within the health insurance industry, emphasizing the urgency of addressing these systemic issues to ensure that patients receive the care they require without undue financial or health-related consequences.

Many Americans receive too much health care. That may finally be changing

Elsa Pearson Sites

StatNews.com

Originally published 8 Nov 23

The opioid crisis rocked America, bringing addiction and overdose into the spotlight. But it also highlighted the overtreatment of pain: Medical and dental providers alike overprescribed opioids after procedures and for chronic conditions. Out of that overtreatment came an epidemic.

In American health care, overtreatment is common. Recently though, there has been a subtle shift in the opposite direction. It’s possible that “less is more” is catching on.

For many Americans, it can be challenging to even access care: Treatment is expensive, insurance is confusing, and there aren’t enough providers. But ironically, we often use too much care, too.

Now, some providers are asking what the line between necessary and unnecessary really is. The results are encouraging, suggesting that, in some cases, it may be possible to achieve the same health outcomes with less treatment — and fewer side effects, too.

This shift is particularly noticeable in cancer care.

The info is here.

Here is my take:

The article delves into the pervasive issue of overtreatment and overdiagnosis in the healthcare system. It highlights the unintended consequences of modern medical practices, where patients are often subjected to unnecessary tests, procedures, and treatments that may not necessarily improve their health outcomes. The article emphasizes how overtreatment can lead to adverse effects, both physically and financially, for patients, while overdiagnosis can result in the unnecessary burden of managing conditions that may never cause harm. The piece discusses the challenges in striking a balance between providing thorough medical care and avoiding unnecessary interventions, urging a shift toward a more patient-centered and evidence-based approach to reduce harm and improve the overall quality of healthcare.

The author suggests that addressing the issue of overtreatment and overdiagnosis requires a comprehensive reevaluation of medical practices, incorporating shared decision-making between healthcare providers and patients. The article underscores the importance of fostering a healthcare culture that prioritizes the avoidance of unnecessary interventions and aligns treatments with patients' preferences and values. By acknowledging and addressing the challenges associated with overmedicalization, the article advocates for a more thoughtful and personalized approach to healthcare delivery that considers the potential harm of unnecessary treatments and strives to enhance the overall well-being of patients.

Personality and prosocial behavior: A theoretical framework and meta-analysis

Thielmann, I., Spadaro, G., & Balliet, D. (2020).

Psychological Bulletin, 146(1), 30–90.

https://doi.org/10.1037/bul0000217

Abstract

Decades of research document individual differences in prosocial behavior using controlled experiments that model social interactions in situations of interdependence. However, theoretical and empirical integration of the vast literature on the predictive validity of personality traits to account for these individual differences is missing. Here, we present a theoretical framework that identifies 4 broad situational affordances across interdependent situations (i.e., exploitation, reciprocity, temporal conflict, and dependence under uncertainty) and more specific subaffordances within certain types of interdependent situations (e.g., possibility to increase equality in outcomes) that can determine when, which, and how personality traits should be expressed in prosocial behavior. To test this framework, we meta-analyzed 770 studies reporting on 3,523 effects of 8 broad and 43 narrow personality traits on prosocial behavior in interdependent situations modeled in 6 commonly studied economic games (Dictator Game, Ultimatum Game, Trust Game, Prisoner’s Dilemma, Public Goods Game, and Commons Dilemma). Overall, meta-analytic correlations ranged between −.18 ≤ ρ̂ ≤ .26, and most traits yielding a significant relation to prosocial behavior had conceptual links to the affordances provided in interdependent situations, most prominently the possibility for exploitation. Moreover, for several traits, correlations within games followed the predicted pattern derived from a theoretical analysis of affordances. On the level of traits, we found that narrow and broad traits alike can account for prosocial behavior, informing the bandwidth-fidelity problem. In sum, the meta-analysis provides a theoretical foundation that can guide future research on prosocial behavior and advance our understanding of individual differences in human prosociality.

Public Significance Statement

This meta-analysis provides a theoretical framework and empirical test identifying when, how, and which of 51 personality traits account for individual variation in prosocial behavior. The meta-analysis shows that the relations between personality traits and prosocial behavior can be understood in terms of a few situational affordances (e.g., a possibility for exploitation, a possibility for reciprocity, dependence on others under uncertainty) that allow specific traits to become expressed in behavior across a variety of interdependent situations. As such, the meta-analysis provides a theoretical basis for understanding individual differences in prosocial behavior in various situations that individuals face in their everyday social interactions.

A pdf is here.

A massive review of the literature finds that the best predictors of pro-social behavior are:

1. social value orientation
2. proneness to feel guilt
3. humility/honesty