The COVID-19 pandemic has necessitated social distancing to mitigate community spread of the coronavirus. Social distancing recommendations have increased the number of people that report delaying or missing health care visits in 2020, including for preventive services. We do not yet know the extent to which COVID-19 or the associated economic impact has affected access to care. However, most recent available data can shed light on how the cost of care affects health care access.
In this chart collection and a related brief, we explore pre-pandemic trends in how cost reasons affect access to care in the U.S. based on the National Health Interview Survey (NHIS) data through 2019. Notably, 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.
Most adults are in good health and have health insurance
In the U.S., most adults (88%) have health insurance, and the majority (85% 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, one in ten 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 one in every ten adults (10.5%) – said that they either delayed or did not receive medical care due to cost reasons in 2019.
Hispanic and Black adults had higher rates of delaying or going without medical care
Hispanic and Black 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 to delay or go without care due to cost reasons
Nearly 20% of adults in worse health delayed or did not receive medical care due to cost barriers, while 9% of adults in better health reported the same.
Share of uninsured adults delaying or going without care due to cost is higher than the share of insured adults
More than one in three uninsured adults (37%) said they delayed or went without health care because of cost reasons. Meanwhile, 7% of adults who have health insurance reported encountering cost-related barriers to accessing care.
While the number of uninsured might not substantially change during the COVID-19 pandemic, cost barriers to care might increase due to income or job loss.
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 job loss have increased during the COVID-19 pandemic, likely worsening individuals delaying or not getting medical care due to cost reasons.
Adults reported going without dental and prescription drugs the most due to cost reasons
One in four adults went without dental care (24%), and 12% of adults went without prescription drugs due to cost reasons, higher than the share of adults who went without medical care (11%) or mental health (5%).
Share of uninsured delaying or going without care has increased in the last few years
From 2016-2018, share of uninsured delaying or going without medical care increased by three percentage points, whereas the share of insured individuals delaying or going without medical care changed by less than one percentage point over the same three years.
The trend from 2018 to 2019 in 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 and those in worse health are more likely to worry about their ability to pay medical bills
Three-quarters of uninsured adults (76%) 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 health status is not as great as with insurance status.
Uninsured adults and adults in worse health are more likely to have problems paying medical bills
About one in every four adults who reported being in worse health 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 (8%). One in three uninsured adults (36%) 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 (45.2%) than the share of insured adults (82.6%). 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.
In 2020, one in three adults delayed or did not get medical care because of COVID-19
More recent information from the CDC’s Household Pulse Survey suggests the number of people who delayed or went without getting needed medical care has increased during the pandemic in 2020. In November 2020, one in three adults report they delayed or did not get medical care for something other than coronavirus.