TY  - JOUR
T1  - U.S. Health Care System Challenges: Examining Health Care Affordability Across Generations – Empirical Evidence of COVID–19 Pandemic
AU  - Bahhouth, Victor
AU  - Bahhouth, Andrew
PY  - 2025
DA  - October
Y2  - 2025
DO  - 10.48121/jihsam.1753550
JF  - Journal of International Health Sciences and Management
PB  - Sedat BOSTAN
WT  - DergiPark
SN  - 2149-9519
SP  - 119
EP  - 128
VL  - 11
IS  - 22
LA  - en
AB  - This paper examines the United States health care system challenges during COVID-19 pandemic. It tests the transgenerational groups’ health care affordability during the pandemic, considering the various demographic and socio–demographic characteristics that influenced such experiences. We first hypothesize that different generations’ medical challenges were not felt equally across the generations. Second, our hypothesis is that the characteristics of different groups with different medical challenges were also not the same.  To test our hypotheses, we use data from the 2021 wave of the National Financial Capability Survey (NFCS), apply Chi–Square tests, and estimate logistic regressions. The overall results are supportive of our hypotheses. The paper advances knowledge of the intricate connection between medical costs and financial hardship in cross-generational settings during the COVID-19 epidemic. To overcome the continuous difficulties brought on by health crises and economic downturns, it emphasizes the significance of developing social cohesion and economic resilience across generations.
KW  - Medical cost
KW  - Transgenerational
KW  - COVID-19 Pandemic
KW  - Health crisis
CR  - Ahmad, F., Cisewski, J., and Anderson, R. (2023). Mortality in the United States — Provisional Data, 2023. Weekly / August 8, 2024 / 73(31);677–681. doi: 10.15585/mmwr.mm7331a1
CR  - Bor, J., Raquib, R., Wrigley-Field, E., Woolhandler, S., Himmelstein, D., and Stokes, A. (2025). Excess death before, during, and after COVID-19 pandemic. JAMA Health Forum. Published Online: May 23, 2025. 2025;6;(5):e251118. doi:10.1001/jamahealthforum.2025.1118
CR  - Butzner, M. and Cuffee, Y. (2021, August). Telehealth interventions and outcomes across rural communities in the United States: Narrative review. Journal of Medical Internet Research, Vol 23, No 8. https://www.jmir.org/2021/8/e29575
CR  - Carey, N., Coley, R., Hawkins, S., and Baum, C. (2024 July). Emerging adult mental health during COVID: Exploring relationships between discrete and cumulative individual and contextual stressors and well-being. Journal of Adolescent Health: Improving the Lives of Adolescents and Young Adults, 75(1), 26-35.
CR  - Centers for Disease Control and Prevention. (2023, May 30). Risk for COVID-19 infection, hospitalization, and death by age group. Retrieved from https://archive.cdc.gov/ www_cdc_gov/coronavirus/2019-ncov/covid-data/investigations-discovery/ hospitalization-death-by-age.html
CR  - Centers for Disease Control and Prevention. Public health Infrastructure Grant Report (2024). https://www.cdc.gov/infrastructure-phig/about/index.html
CR  - CFPB, Consumer Financial Protection Bureau (2021). Medical debt among older adults before the pandemic, CFPB Office for Older Americans.
CR  - Collin, B. and Fingerhut, H. (2021, December 6). Pandemic stress weighs heavily on Gen Z: AP-NORC, MTV poll Retrieved from https://apnews.com/article/coronavirus-pandemic-health-lifestyle-anxiety-generations-d79bee29d08f68b85c5b537ebf5004ed
CR  - Dickler, J. (2021, January 27). 51 million Americans increased their credit card debt because of Covid. Retrieved www.cnbc.com/2021/01/27/millions-of-americans-boosted-their-credit-card-debt-because-of-covid.html
CR  - Elkin C (2025). Why medication assisted treatment works for opioid addiction. National Addiction Specialists. https://www.nationaladdictionspecialists.com/is-medication-assisted-treatment-effective/
CR  - Freelander, L., Rickless, D., Anderson, C., Curriero, F., Rockhill, S., Mirsajedin, A. … Wong, D. (2023, December 27). The impact of COVID-19 on healthcare coverage and access in racial and ethnic minority populations in the United States. Geospat Health. 18(2) :10.4081/gh.2023.1222. doi: 10.4081/gh.2023.1222
CR  - Golberstein, E., Wen, H., & Miller, B. F. (2020, April 14). COVID-19 and mental health for children and adolescents. JAMA Pediatrics, 174(9), 819-820. doi:10.1001/jamapediatrics. 2020. 1456
CR  - Hair J., Black W., Babin B., and Anderson E. (2018). Multivariate Analysis, eighth edition, Cengage.
CR  - Hilberath, J., Mast, A.S., Holweg, M., Kränkel, L., Remppis, J., Renk, H….Slavetinsky, C. (2024, January 23). Quality of life and healthcare utilization during the COVID-19 pandemic are more restricted in chronically ill than in healthy children: a tertiary care children’s hospital experience. European Journal of Pediatrics. 183(4):1801–1810. doi: 10.1007/s00431-023-05382-6
CR  - Himmelstein, D. U., Dickman, S. L., McCormick, D., Bor, D. H., Gaffney, A., and Woolhandler, S. (2022). Prevalence and risk factors for medical debt and subsequent changes in social determinants of health in the US. JAMA Network Open 5(9): e2231898
CR  - Khazanchi, R., Brewster, R., Tolliver, D., Heard-Garris, N.J., Vasan, A., Winkleman, T., and Hadland, S. (2025). Adverse childhood experiences and unmet health care needs due to cost and the COVID-19 pandemic: A nationally representative analysis of U.S. adolescents. Journal of Adolescent Health 30, 1-10
CR  - Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. (2020, May). Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 4(5), 10-11. https://doi: 10.1016/S2352-4642(20)30108-5.
CR  - Lee, Y., Mozaffarian, D., Micha, R., and Gaziano, T. (2019). Prescribing healthy foods could bring cost-effective benefits. National Institute of Health (NIH): https://www.nih.gov/news-events/nih-research-matters/prescribing-healthy-foods-could-bring-cost-effective-benefits
CR  - Leonhardt, M. (2020, August 4) Millennials, Gen-Z twice as likely as their parents to say Covid-19 upended their financial security. Retrieved from https://www.cnbc.com/2020/08/04/nearly-1-in-3-millennials-gen-z-say-covid-19-negatively-impacted-financial-security.html
CR  - Mendes de Leon, C. and Griggs, J. (2021, July). Medical debt as a social determinant of health. The Journal of the American Medical Association. 326(3), 228-229. https:// doi:10.1001/jama.2021.9011
CR  - Millett GA, Jones AT, Benkeser D, Baral S, Mercer L, Beyrer C, Honermann B, Lankiewicz E, Mena L, Crowley JS, Sherwood J, Sullivan PS. Assessing differential impacts of COVID-19 on black communities. Annals of Epidemiology (2020, July). 47, 37-44. https://doi: 10.1016/j.annepidem.2020.05.003.
CR  - National Financial Capabilities Study Data (NFCS, 2021) - Published by FINRA Investor Education Foundation: https://www.finrafoundation.org/nfcs-data-and-downloads
CR  - Oosterhoff, M., Kouvenberg, L., Rotteveel, A., van Vliet, E., Stadhouders, N., de Wit, G.A., van Giessen, A. (2023, January 4). Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands. Social Science and Medicine, 320, doi: 10.1016/j.socscimed.2023.115658
CR  - Parikh, M. J., Gabriel, N. M., Gryszko, V., & Erkmen, C. P. (2024). Understanding the spectrum of esophageal cancer disparities. Foregut, 4(4), 458-466. https://doi.org/10.1177/ 26345161231182108
CR  - Parmar N. (2023, August). The economics of healthcare reform: Comparative analysis of universal healthcare systems. International Journal of Research in all Subjects in Multi Language.11(8). https://www.raijmr.com/ijrsml/wp-content/uploads/2023/10/IJRSML_2023_vol11_issue_08_Eng_04.pdf
CR  - Qiu, Y., Hung, H., Gai, J., and DeLeo, G. (2024, December). The effects of the COVID-19 pandemic on age-based disparities in digital health technology use: Secondary analysis of the 2017-2022 health information national trends survey. Journal of Medical Internet Research. https://doi: 10.2196/65541.
CR  - Seigel, K., Bullard, K., and Imperatore, G. (2016, August). Association of higher consumption of foods derived from subsidized commodities with adverse cardiometabolic risk among us adults. JAMA Internal Medicine,176(8):1124-1132. doi:10.1001/jamainternmed. 2016.2410. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2530901
CR  - Siegel, M. (2024, August). Universal background checks, permit requirements, and firearm homicide rates. 7(8): e2425025. doi:10.1001/jamanetworkopen.2024.25025. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821813
CR  - The British Academy (2021). The COVID decade: Understanding the long-term societal impacts of COVID-19. Retrieved from https://www.thebritishacademy.ac.uk/documents/3238/ COVID-decade-understanding-long-term-societal-impacts-COVID-19.pdf
CR  - The impact of chronic underfunding on America’s public health system: Trends, risks, and recommendations. Trust for America’s Health Report (2024). (2024, August). https://www.tfah.org/wp-content/uploads/2024/08/2024-PublicHealthFunding-FINAL.pdf
CR  - Thomeer, M., Yahirun, J., Colón-López, A. (2020, December). How families matter for health inequality during the COVID-19 pandemic. Family Theory and Review 12(4): 448–463. http:// doi:10.1111/jftr.12398.
CR  - Williams, R., Srinivasan, A., and Periasamy, M. (2024, June 11). Exploring the impact of COVID-19 on the healthcare system and vulnerable populations in the United States. International Journal of Medical Students https://doi: 10.5195/ijms.2024.2088
CR  - Yabroff, K. R., Zhao, J., Han, X., & Zheng, Z. (2019, May). Prevalence and correlates of medical financial hardship in the USA. Journal of General Internal Medicine, 34, https://doi.org/ 10.1007/s11606-019-05002-w.
CR  - Yanful B., Kirubarajan A., Bhatia D., Mishra S., Allin S., & Di Ruggiero E. (2023). Quality of care in the context of universal health coverage: a scoping review. Health Research Policy and Systems. 21. https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00957-5.
UR  - https://doi.org/10.48121/jihsam.1753550
L1  - https://dergipark.org.tr/en/download/article-file/5102134
ER  -