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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. 2022;112(3):491–498. https://doi.org/10.2105/AJPH.2021.306617 )

Americans facing large health-related expenses have increasingly turned to online crowdsourced funding for support, initiating 250,000 medical fundraisers on GoFundMe in 2018. Recent research indicates that these fundraisers yield inequitable outcomes, with White crowdfunding beneficiaries receiving higher levels of support than non-White beneficiaries. Researchers fear that racialized impressions of deservingness may be a driver of unequal returns in crowdfunding. However, rather than being a direct effect of interpersonal racism, differences in returns may be an indirect effect of the systemic racism that causes the social networks of Black and Hispanic Americans to have lower access to financial capital. This paper is the first to focus on how unequal access to monetary capital in networks of potential crowdfunding donors drives unequal returns for beneficiaries. I analyze a geographically stratified sample of 2,618 GoFundMe campaigns coded for perceived race and ethnicity of the beneficiary. I estimate donor financial capacity for each campaign based on the geography of Facebook friend networks and the most likely racial and ethnic makeup of the donor pool, based on donor surnames. I show that variations in the estimated income of potential donors can account for much of the deficit in returns. Thus, even in the absence of interpersonal discrimination, crowdfunding is unlikely to yield equitable outcomes given the current distribution of financial resources in the United States.

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