A cross-sectional study of social inequities in medical crowdfunding campaigns in the United States

Abstract: Americans are increasingly relying on crowdfunding to pay for the costs of healthcare. In medical crowdfunding, online platforms allow individuals to appeal to social networks to request donations for health and medical needs. Users are often told that success depends on how they organize and share their campaigns to increase social network engagement. However, experts have cautioned that MCF could exacerbate health and social disparities by amplifying the choices and biases of the crowd and leveraging these to determine who has access to financial support for healthcare. To date, research on potential axes of disparity in MCF, and their impacts on fundraising outcomes, has been limited. This paper presents an exploratory cross-sectional study of a randomized sample of 637 MCF campaigns on the popular platform Gofundme, for which the race, gender, age, and relationships of campaigners and campaign recipients were categorized alongside campaign characteristics and outcomes. Our analyses examine race, gender, and age disparities in MCF use, and tests how these are associated with differential campaign outcomes. The results show systemic disparities in MCF use and outcomes: non-white users are under-represented. There is significant evidence of an additional digital care labor burden on women organizers of campaigns, and marginalized race and gender groups are associated with poorer fundraising outcomes. Outcomes are only minimally associated with campaign characteristics under users' control, such as photos, videos, and updates. These results corroborate widespread concerns how technology fuels health inequities, and about how crowdfunding may be creating an unequal and biased marketplace for those seeking financial support to access healthcare. Further research and better data access are needed to explore these dynamics more deeply and inform policy for this largely unregulated industry.