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      Medical Crowdfunding and Disparities in Health Care Access in the United States, 2016‒2020

      Author(s): 1 , 1
      Publication date (Electronic):
      Journal: American Journal of Public Health
      Publisher: American Public Health Association

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          Abstract

          Objectives. To assess whether medical crowdfunding use and outcomes are aligned with health financing needs in the United States.

          Methods. We collected data on 437 596 US medical GoFundMe campaigns between 2016 and 2020. In addition to summarizing trends in campaign initiation and earnings, we used state- and county-level data to assess whether crowdfunding usage and earnings were higher in areas with greater medical debt, uninsured populations, and poverty.

          Results. Campaigns raised more than $2 billion from 21.7 million donations between 2016 and 2020. Returns were highly unequal, and success was low, especially in 2020: only 12% of campaigns met their goals, and 16% received no donations at all. Campaigns in 2020 raised substantially less money in areas with more medical debt, higher uninsurance rates, and lower incomes.

          Conclusions. Despite its popularity and portrayals as an ad-hoc safety net, medical crowdfunding is misaligned with key indicators of health financing needs in the United States. It is best positioned to help in populations that need it the least. (Am J Public Health. Published online ahead of print February 3, 2022:e1–e8. https://doi.org/10.2105/AJPH.2021.306617 )

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          Producing a worthy illness: Personal crowdfunding amidst financial crisis

          Lauren S. Berliner, Nora Kenworthy (2017)
          Article 0 comments Cited 59 times – based on 0 reviews     Review now
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            Addressing the social determinants of children's health: a cliff analogy.

            Camara Jones, Clara Jones, Geraldine Perry … (2009)
            This paper presents a "Cliff Analogy" illustrating three dimensions of health intervention to help people who are falling off of the cliff of good health: providing health services, addressing the social determinants of health, and addressing the social determinants of equity. In the terms of the analogy, health services include an ambulance at the bottom of the cliff, a net or trampoline halfway down, and a fence at the top of the cliff. Addressing the social determinants of health involves the deliberate movement of the population away from the edge of the cliff. Addressing the social determinants of equity acknowledges that the cliff is three-dimensional and involves interventions on the structures, policies, practices, norms, and values that differentially distribute resources and risks along the cliff face. The authors affirm that we need to address both the social determinants of health, including poverty, and the social determinants of equity, including racism, if we are to improve health outcomes and eliminate health disparities.
            Article 0 comments Cited 37 times – based on 0 reviews     Review now
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              A cross-sectional study of social inequities in medical crowdfunding campaigns in the United States

              Nora Kenworthy, Zhihang Dong, Anne Montgomery … (2020)
              Americans are increasingly relying on crowdfunding to pay for the costs of healthcare. In medical crowdfunding (MCF), online platforms allow individuals to appeal to social networks to request donations for health and medical needs. Users are often told that success depends on how they organize and share their campaigns to increase social network engagement. However, experts have cautioned that MCF could exacerbate health and social disparities by amplifying the choices (and biases) of the crowd and leveraging these to determine who has access to financial support for healthcare. To date, research on potential axes of disparity in MCF, and their impacts on fundraising outcomes, has been limited. To answer these questions, this paper presents an exploratory cross-sectional study of a randomized sample of 637 MCF campaigns on the popular platform GoFundMe, for which the race, gender, age, and relationships of campaigners and campaign recipients were categorized alongside campaign characteristics and outcomes. Using both descriptive and inferential statistics, the analysis examines race, gender, and age disparities in MCF use, and tests how these are associated with differential campaign outcomes. The results show systemic disparities in MCF use and outcomes: people of color (and black women in particular) are under-represented; there is significant evidence of an additional digital care labor burden on women organizers of campaigns; and marginalized race and gender groups are associated with poorer fundraising outcomes. Outcomes are only minimally associated with campaign characteristics under users’ control, such as photos, videos, and updates. These results corroborate widespread concerns with how technology fuels health inequities, and how crowdfunding may be creating an unequal and biased marketplace for those seeking financial support to access healthcare. Further research and better data access are needed to explore these dynamics more deeply and inform policy for this largely unregulated industry.
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                Author and article information

                Journal
                Title: American Journal of Public Health
                Abbreviated Title: Am J Public Health
                Publisher: American Public Health Association
                ISSN (Print): 0090-0036
                ISSN (Electronic): 1541-0048
                Publication date (Electronic): February 03 2022
                Pages: e1-e8
                Affiliations
                [1 ]Nora Kenworthy is with the School of Nursing and Health Studies, University of Washington, Bothell. Mark Igra is with the Department of Sociology, University of Washington, Seattle.
                Article
                DOI: 10.2105/AJPH.2021.306617
                PubMed ID: 35113726
                SO-VID: f1474688-87d6-4178-99b9-d8fd5e360745
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