Avoided Care Due to Cost (As per America's Health Rankings)

U.S. Value: 9.8% (2020); 8.8% (2021); 10.1 (2022)

Healthiest State: Hawaii: 6.0% (2020); 5.3% (2021);

Least-healthy State: Texas: 15.2% (2020); 15.9% (2021)

Definition: Percentage of adults who reported a time in the past 12 months when they needed to see a doctor but could not because of cost

Data Source & Year(s): CDC, Behavioral Risk Factor Surveillance System, 2020

Suggested Citation: America's Health Rankings analysis of CDC, Behavioral Risk Factor Surveillance System, United Health Foundation, AmericasHealthRankings.org, accessed 2022.

WHY DOES THIS MATTER?

The United States spends more on health care than any other country in the Organisation for Economic Co-operation and Development (OECD), yet provides fewer resources and ranks 29th for life expectancy at birth of the 38 member nations. The high cost of health care in the U.S. is a major barrier to accessing health care, along with inadequate or no insurance coverage, transportation issues, negative interactions with providers and care teams, delayed access and issues with childcare or work schedules. 

Lack of access to health care has long been associated with increased preventable hospitalizations and missed opportunities to prevent disease and manage chronic conditions, all of which can lead to worse and more expensive health outcomes. Meanwhile, the cost of U.S. health care is projected to continue trending upward for the next 30 years. Currently, the average American spends more than $11,000 a year on health care.

WHO IS AFFECTED?

Adults who are uninsured are more likely to have problems paying medical bills compared with adults who had health insurance. Even among insured adults, those enrolled in high-deductible health plans are nearly twice as likely to delay or entirely forgo care due to cost compared with adults enrolled in traditional health plans.

Populations of adults who have a higher prevalence of avoiding care due to cost include:

• Females compared with males.
• Adults ages 18-44, who have a prevalence four times higher than adults ages 65 and older. As age increases, avoiding care due to cost significantly decreases.
• Hispanic adults compared with Asian adults.
• Adults with less than a high school education, who have a prevalence of avoiding care due to cost more than three times higher than that of college graduates. 
• Adults with an annual household income less than $25,000, who have a prevalence five times higher than that of adults with an annual household income of $75,000 and above. As income level increases, the prevalence of avoiding care due to cost significantly decreases.

GOALS

Reducing the proportion of adults who are unable to obtain or delay in obtaining necessary medical care is a Healthy People 2030 objective. 

Source: https://www.americashealthrankings.org/explore/annual/measure/costburden/state/IN Last accessed Dec 2022

https://www.americashealthrankings.org/explore/annual/measure/costburden/state/IN. Last accessed June 2022

WHAT WORKS?

Multidisciplinary interventions that increase the affordability of health care by preventing disease and reducing out-of-pocket costs may have an impact on reducing the proportion of adults who avoid care due to the cost. Examples include:

• Patient-centered care and shared decision-making have been shown to reduce cost of care by increasing health education and empowering patients to choose cost-effective diagnostic tools and treatment options.
• Primary care management reduces costs by increasing continuity of care and reducing expensive emergency room and specialty care visits. 

The American Medical Association recommends several strategies to improve access to health care, including expanding Medicaid in more states and addressing physician shortages.

https://www.americashealthrankings.org/explore/annual/measure/costburden/state/IN. Last accessed Dec 2023

The reality is that the healthcare problem is multifaceted. 

THE LARGEST COMPONENT of higher U.S. medical spending is the cost of healthcare administration. About one-third of healthcare dollars spent in the United States pays for administration; Canada spends a fraction as much. Whole occupations exist in U.S. medical care that are found nowhere else in the world, from medical-record coding to claim-submission specialists. Standardization lacks as every health insurer requires a different bar-code-equivalent and payment-systems submission. Almost all hospitals have electronic medical records, but there is no federal requirement that they interface. Indeed, many providers take active steps to avoid electronic interchange, because keeping records local ensures that fewer patients will switch doctors. Alternatively, the federal government sees its role only as providing insurance to people.

Pharmaceutical prices are higher in the United States than example in Canada and at star hospitals as compared to community institutions. Use of generic medicines are not enough to drive prices down significantly. Few people are willing to switch from a star hospital to a community institution, even if the price is much lower (mostly because their physician directs tem there). Prestigious hospitals charge multiple times what less prestigious hospitals do for the same service and patients are not encouraged to questioning their physician or negotiate prices with hospitals. 

A growing number of economists call for price regulation. The major challenge to implementing such a policy is the possible unintended consequences. If pharmaceutical manufacturers or academic hospitals got less money, what would they cut out - reserach and development? 

Higher medical spending in the United States means higher utilization. The United States has the most technologically sophisticated medical system of any country, and it shows up in spending: the U.S. has four times the number of MRIs per capita as Canada, and three times the number of cardiac surgeons. Americans don’t see the doctor any more often than Canadians do, and are not hospitalized any more frequently, but when they do interact with the medical system, it is much more intensively. Further, COVID-19 highlighted some major shortcomings like perdiatric hospital beds, dissatisfied nurses, and shortages in emeregency rooms capacity.

Source: https://www.harvardmagazine.com/2020/05/feature-forum-costliest-health-care Last accesses 6/23/2022 

https://news.gallup.com/opinion/polling-matters/468893/challenge-healthcare-reform.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication Last accesses 01/20/2023

Gallup predicted a record high of individuals in 2022 that did not seek care due to cost. This goes hand-in-hand with the highest inflation rate reported in 40 years. Of concern is Gallup's report that more than twice of respondents said that the care needed was related to “very” or “somewhat” serious condition or illness as appose to “not very” or “not at all” serious. 

Source: https://news.gallup.com/poll/468053/record-high-put-off-medical-care-due-cost-2022.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication     Last accessed 1/17/2023

Gallup also reported other challenges with healthcare. Despite having the highest cost of healthcare in the world, it is not outperforming other developed countries on health outcomes like life expectancy, infant mortality and unmanaged diabetes.

https://news.gallup.com/opinion/polling-matters/468893/challenge-healthcare-reform.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication Last accesses 01/20/2023

Communicate with Legislative affairs on policy decisions.

https://www.americashealthrankings.org/explore/measures/costburden/IN Last accessed April 2024

https://www.americashealthrankings.org/explore/annual/measure/costburden/state/IN?edition-year=2022. Last accessed 02/02/2023.

https://www.americashealthrankings.org/explore/annual/measure/costburden/state/IN. Last accessed Dec 2022