How does cost affect access to care?

In this chart collection, we explore trends in how costs affect access to care in the U.S. based on the National Health Interview Survey (NHIS) data through 2020.

In the 2020 NHIS survey, 1 in 11 adults reported delaying or going without medical care due to cost reasons. Other polling data suggest the share of adults delaying or not getting care due to cost reasons may be still higher. The number of adults reporting delaying or not getting medical care due to cost reasons slightly decreased from 2019 to 2020. Though this trend could be driven by several COVID-19 pandemic related disruptions. First, COVID-19 posed an additional barrier to accessing care and fewer people got care in 2020, thus, costs were not necessarily the primary reason why adults delayed or did not get care in 2020. Additionally, NHIS shifted from in-person interviews to all-telephone interviews in March 2020, which may have affected differences in survey results from 2019 to 2020.

Most adults are in good health and have health insurance


At any given point in time, most adults (89%) have health insurance, and the majority (86% of adults) also report their health as at least good. Adults in worse health (reported as fair or poor health status), and the uninsured are much more likely than others to delay or forgo health care due to costs.

Yet still, 1 in 11 adults reported that they delayed or did not get care because of cost reasons


Most Americans do not report cost-related access barriers to health care. Still, a substantial portion of the population – about 1 in every 11 adults (9%) – said that they either delayed or did not receive medical care due to cost reasons in 2020. Though the share of people reporting not delaying or getting care due to cost reasons slightly decreased from 2019 to 2020, this is because care was delayed or did not happen due to the COVID-19 pandemic in 2020.

Over a quarter of adults reported that they delayed or did not get care because of COVID-19


In 2020, a greater share of the population attributed delaying or foregoing care to COVID-19 (26%) than to cost-related reasons (9%).

Hispanic adults had higher rates of delaying or going without medical care due to costs


Hispanic adults had higher rates of going without medical care due to costs than other groups.

Adults who are in worse health are twice as likely than those with better health to delay or go without care due to cost reasons


16% of adults in worse health delayed or did not receive medical care due to cost barriers, while 8% of adults in better health reported the same. 

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Share of uninsured adults delaying or going without care due to cost is higher than the share of insured adults


Almost one in three uninsured adults (30%) said they delayed or went without health care because of cost reasons. Meanwhile, 6% of adults who have health insurance reported encountering cost-related barriers to accessing care.

While the number of uninsured did not substantially change during the COVID-19 pandemic, cost barriers to care might increase due to income or job loss, particularly for lower income people.

Adults with incomes below 200% of the federal poverty level are more likely to go without medical care


Adults with incomes below 200% federal poverty level (FPL) are more likely to delay or go without medical care than those with incomes above 200% FPL. 

Income and employment have decreased during the COVID-19 pandemic, likely worsening individuals delaying or not getting medical care due to cost reasons.

Adults reported delaying or going without dental care and prescription drugs the most due to cost reasons


Almost one in four adults went without dental care (23%), and 11% of adults delayed or went without prescription drugs due to cost reasons, which is higher than the share of adults who went without medical care (9%) or mental health (5%).

The share of uninsured people delaying or going without care declined in 2020


From 2016-2018, the share of uninsured adults delaying or going without medical care increased by almost three percentage points, whereas the share of insured individuals delaying or going without medical care held mostly steady over the same three years.

Starting with the 2019 NHIS survey, the U.S. Centers for Disease Control and Prevention (CDC) redesigned the questionnaire, and updated the sampling weights methodology. As a result, changes in estimates from 2018 to 2019 cannot be attributed to actual change over time alone. We have indicated the break in the survey when presenting measures over time. The trend from 2018 to 2019 in the percent of adults delaying or foregoing care is likely at least partly due to changes to NHIS questionnaire and sampling weights, rather than actual changes in access to care alone.

Uninsured adults continue to face access barriers due to cost of care. In 2020, 30% of uninsured adults reported delaying or not getting care due to cost reasons compared to 6% of insured adults. While the share reporting delaying or not getting care due to cost reasons decreased from 2019 to 2020, much of this is because COVID-19 presented another reason care was delayed or foregone. COVID-related stay-at-home measures, potential risk of infection at doctors’ offices and hospitals, and concerns over hospital capacity led to sharp declines in utilization.

Uninsured adults and those in worse health are more likely to worry about their ability to pay medical bills


Overall, almost 1 in 2 adults worry about their ability to pay medical bills if they get sick or have an accident. Over three-quarters of uninsured adults (78%) are very or somewhat worried about paying medical bills in case they get sick or have an accident. Adults in worse health have higher rates of worrying about paying for medical bills than those in at least good health. However, the disparity between uninsured and insured is greater than the disparity between those with worse health and better health.

Uninsured adults and adults in worse health are more likely to have problems paying medical bills


Of the adults who reported being in worse health, about one in four also reported difficulty paying bills for medical care. A similar rate of uninsured adults had difficulty paying medical bills.

One in three uninsured adults did not have a usual place of care


Compared to those in better health (11%), a lower share of people in worse health did not have a usual place of care (5%). About one in three uninsured adults (32%) did not have a usual place of care, in contrast to 7% of those with insurance.

Uninsured adults are more likely to use urgent care or an emergency room as their usual place of care


A smaller share of uninsured adults used a doctor’s office or a health center as their usual place of care (48%) than the share of insured adults (83%). On the other hand, a greater share of uninsured adults used urgent care or retail clinics, or the emergency room as their usual place of care.  

The Peterson Center on Healthcare and KFF are partnering to monitor how well the U.S. healthcare system is performing in terms of quality and cost.

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