Urban Institute: Medical Debt Landscape
| Details | medical debt in collections estimates |
|---|---|
| Topics | medical debt in collections, hospital market concentration, hospital closures and mergers |
| Source | Urban Institute |
| Years Available | 2011-2023 |
| Geographies | County, State |
| Public Edition or Subscriber-only | Public Edition |
| Download Available | yes |
| For more information | https://apps.urban.org/features/medical-debt-over-time/ |
| Last updated on PolicyMap | September 2025 |
Description:
This dataset provides national, state, and county-level information on medical debt in collections, along with related measures such as hospital market concentration, hospital closures and mergers, uninsured population, disabled adults, and average household income. Medical debt estimates come from the Urban Institute Credit Bureau Panel, which includes a 2% random sample of consumers from 2011-2019 (over 5 million individuals per year) and a 4% sample from 2020-2023 (over 10 million per year). Hospital market concentration is derived from the American Hospital Association Annual Survey Database, closures and mergers from the CMS Provider of Services File, and demographic data—including uninsured rates, disabled adults, household income, and racial composition—from the U.S. Census Bureau’s American Community Survey (ACS). One-year ACS estimates are used for national and state statistics, while five-year estimates are used for counties and ZIP Code Tabulation Areas (ZCTAs).
Since the credit bureau data do not include race or ethnicity, measures for white communities and communities of color are assigned based on the racial composition of ZCTAs. White community values represent areas where at least 50% of residents are non-Hispanic white, and communities of color represent areas where at least 50% of residents are Black, Hispanic, Asian or Pacific Islander, American Indian or Alaska Native, multiracial, or other non-white groups. Values may be suppressed (“Insufficient Data”) if fewer than 50 individuals are represented or if no majority-race ZCTAs exist in a geographic area.
Notes: Starting in 2022, paid medical collections, collections less than a year old, and collections under $500 are excluded from credit reports. The median medical debt indicator appears to spike in 2023; this increase largely reflects these reporting changes, as only larger debts remain in the dataset. Additionally, as of August 2023, Colorado excludes all medical debt from credit reports.
Citation: Fredric Blavin, Breno Braga, Noah Johnson, Apueela Wekulom. 2024. The Changing Medical Debt Landscape in the United States. Accessible from https://datacatalog.urban.org/dataset/changing-medical-debt-landscape-united-states.