AbstractBackgroundMedical crowdfunding is increasingly used to finance personal healthcare costs in Canada (CAN), United Kingdom (UK), and United States (US) despite major differences in their healthcare systems. Yet, it lacks comparative descriptive research to guide policy changes that can promote equitable and accessible healthcare.MethodsWe conducted a cross-sectional analysis of Canadian, British, and American campaigns between February 2018 and March 2019 on the GoFundMe platform (n=3,396). We extracted and manually reviewed variables from campaigns on each country’s GoFundMe discovery webpage, explored campaign characteristics, and compared each country’s campaign demographics to its respective national census. We fit multivariate linear regression models for funds raised for the cohort and for each country.ResultsWe examined 1,091 Canadian, 1,082 British, and 1,223 American campaigns. US campaigns (median [IQR] $38,204 [$31,200 to $52,123]) raised more funds than those in CAN ($12,662 [$9,377 to $19,251]) and the UK ($6,285 [$4,028 to $12,348]). Female (38.4% of campaigns vs. 50.9% of US census; p<0.001) and black (5.3% of campaigns vs. 13.4% of US census; p<0.001) beneficiaries were underrepresented in US campaigns. In the full cohort, blacks raised $4,007 less (95% confidence interval [CI] -$6,913 to -$1,101; p=0.007) and males raised $1,742 more (95% CI $583 to $2,901; p=0.003) per campaign. Cancer was the most common diagnosis represented overall (54.5%). Across all diagnoses, campaigns primarily for routine treatment expenses were three times more common in the United States compared to Canada and the United Kingdom (CAN 21.9% vs. UK 26.6% vs. US 77.9%; p<0.001). However, campaigns with routine care were less successful overall, raising $4,589 less per campaign (CI -$6,429 to - $2,749; p<0.001). Campaigns primarily for alternative treatment expenses were nearly five times as common for cancer (24%) than for non-cancer (5%) diagnoses.DiscussionThe trends observed suggest that there are important gaps in healthcare provision in all of the countries examined across a wide range of diagnoses. Although medical crowdfunding has the potential to provide short-term relief from medical financial burden for a privileged subset of patients, it may carry wider-reaching adverse societal effects including the promotion of racial and gender disparities in healthcare. Further work is needed to inform policy changes that promote equitable and accessible healthcare through this practice.FundingNone.
Discretionary Tax Changes and the Macroeconomy: New Narrative Evidence from the United Kingdom
