The relationship between low social/emotional support and health care affordability among rural and urban residents

Purpose: Social/emotional support can help to buffer the health and financial impacts of health care costs. However, little research examines differences in social/emotional support as it relates to health care affordability, and even less examines these issues by rurality despite rural/urban differences in health and health care access. This study addresses these gaps by examining differences in social/emotional support and health care affordability issues among rural and urban adults. Methods: Using weighted data from the 2020 and 2021 National Health Interview Survey (n = 44,987), we examined differences in three health care affordability issues: worry about medical bills, problems paying medical bills, and inability to pay medical bills. We conducted bivariate and multivariate logistic regression analyses comparing these issues by rurality, social/emotional support, and other sociodemographic and health characteristics, generating adjusted odds ratios and predicted probabilities of these issues. Findings: Rural residents were more likely to report problems paying and inability to pay medical bills (13.0% vs. 10.2%, p < 0.001; 8.2% vs 6.2%, p < 0.001). Sociodemographic and health covariates were differentially associated with adjusted odds of health care affordability issues, while low social/emotional support was associated with higher adjusted odds and adjusted predicted probabilities of all three health care affordability issues in both rural and urban areas. Conclusions: Low social/emotional support is associated with higher odds and predicted probabilities of all health care affordability issues regardless of rurality. Future policy aimed at reducing medical debt in rural areas should consider the beneficial impacts of social/emotional support.