Crowdfunding Medical Care: A Comparison of Online Medical Fundraising in Canada, the United Kingdom, and the United States

Abstract

Background: Medical 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. Methods: We 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. Results: We 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. Discussion: The 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.

Characterizing online crowdfunding campaigns for patients with kidney cancer

“…Furthermore, within both our cohort and previously‐published multispecialty cancer work, approximately one quarter of campaigns mentioned that patients were uninsured or under covered 10 . In a cohort of high‐income countries, crowdfunding campaigns for routine treatment expenses were more commonly found in the US 20 . Conceptually, crowdfunding may be a proxy for health inequities, pushing users toward reliance on private financing opportunities as health systems do little to support mounting care costs 4 .…”

“…With the rising financial burden of kidney cancer care in the US, patients and their families may turn to crowdfunding platforms to cover associated costs 10 . GoFundMe® is a widely‐known crowdfunding platform where one‐third of campaigns are health‐related, and is most commonly referenced in preceding crowdfunding literature 10,11,20 …”

New digital safety net or just more ‘friendfunding’? Institutional analysis of medical crowdfunding in the United States

“…There are three ways to access medical campaigns through the US version of the GoFundMe website: accessing a list of 1,000 campaigns selected algorithmically by the site, listed in the 'Medical' category of the 'Discover' page; searching for campaigns with a specific keyword (e.g., 'cancer'); or obtaining a direct link to a campaign through social media or similar means. Like other recent research on GoFundMe (Ren et al, 2020;Saleh et al, 2020), we used the first approach, since it is in practice the most viable means of obtaining a wide variety of campaigns across the US that are guaranteed to be in the medical category. The most viable alternative would be to use the search feature, but that would limit results to campaigns that match pre-defined keywords.…”

New Digital Safety Net or Just More ‘Friendfunding’? Institutional Analysis of Medical Crowdfunding in the United States

“…'cancer'); or obtaining a direct link to a campaign through social media or similar means. Like other recent research on Gofundme (Ren, Raghupathi, & Raghupathi, 2020 Ajufo, Bch, Lehmann, & Medford, 2020), we used the first approach, since it is in practice the most viable means of obtaining a wide variety of campaigns across the US that are guaranteed to be in the medical category. The most viable alternative would be to use the search feature, but that would limit results to campaigns that match pre-defined keywords.…”