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Finances, fear of COVID-19 among reasons why Americans are avoiding care

Understanding the reasons that patients forgo care is an important component in designing policy and clinical interventions.

Jeff Lagasse, Associate Editor

Two out of five individuals delayed or missed medical care in the early phase of the pandemic – from March through mid-July 2020 – according to a new survey from researchers at the Johns Hopkins Bloomberg School of Public Health.

The survey of 1,337 U.S. adults found that 544, or 41%, delayed or missed medical care during that time frame. Among the 1,055 people who reported needing medical care, 29% indicated fear of transmission of COVID-19 as the main reason. Seven percent reported financial concerns as the main reason for delaying or missing care.

The findings were published online in JAMA Network Open.


Understanding the reasons that prospective patients forego care is an important component in designing effective policy and clinical interventions, which is ever more relevant as COVID-19 case numbers surge once more in certain areas.

During the initial phase of the pandemic, the healthcare system experienced major disruptions, including the closures of medical practices, cancellation of elective procedures and the shift of many services to telehealth. As a result of such disruptions, many people missed or postponed medical care, which can lead to increased health complications, cost and delayed diagnosis.

The survey, part of Johns Hopkins COVID-19 Civic Life and Public Health Survey, was fielded from July 7 to July 22, 2020. The sample was drawn from NORC's Amerispeak Panel, a nationally representative online sample of U.S. households. Respondents were asked whether they missed several types of care, including doses of prescription medications, scheduled preventive care visits, scheduled outpatient medical or mental health visits, elective surgical procedures, or care for new severe physical or mental health issues.

Among the 1,337 respondents, 29% reported missing a preventive care visit; 26% reported missing an outpatient general medical appointment; 8% reported missing one or more doses of a prescription medication; 8% reported missing an outpatient mental health appointment; 6% reported missing an elective surgery; and 3% reported not receiving healthcare for a new severe mental or physical health issue.

Among the 1,055 individuals who reported needing medical care from March to mid-July 2020, more than half, 52%, reported missing care. Among those, 58% who had a scheduled preventive care appointment missed the appointment, and 60% with a scheduled elective surgical procedure skipped the procedure. About half of respondents with a new severe mental health or physical health issue that started after the start of the pandemic reported not seeking care for a new health issue.

The survey also found disruptions to prescription medication. Among 725 respondents who reported taking a prescription medication, three times as many Hispanic respondents reported missing prescription medications compared to non-Hispanic white respondents – 30% compared to 10%. Twenty-two percent of respondents aged 18-34 reported missing prescription medication compared to 6% of adults over 65 and 16% of those aged 35-49. 

Twenty-seven percent of respondents in households with incomes less than $35,000 a year reported missing prescription medications compared to 6% of respondents in households with higher incomes of at least $75,000. Thirty-six percent of those insured through Medicaid reported a higher frequency of missed prescription medications, compared to 10% of those with commercial insurance.

Finally, among those who reported needing medical care, respondents who were unemployed reported higher frequencies of any forgone medical care (65% vs. 50%); missed doses of medications (39% vs. 13%); and missed scheduled appointments (70% vs. 56%), compared to those who were employed.


A July 2020 survey found another reason why people may be avoiding medical care: The burden of finding, accessing and paying for healthcare.

More than two-thirds of consumers in the 2020 Change Healthcare – Harris Poll Consumer Experience Index, a national survey of 1,945 consumers conducted by the Harris Poll and commissioned by Change Healthcare, said every step of the healthcare process is a chore. Most said they don't know how much a treatment or visit costs until months later, and nearly all said they want shopping for healthcare to be as easy as shopping for other common services, and want it to be a fully connected digital experience.

A new rule that went into effect on January 1 requires hospitals to post their charges for 300 shoppable services and to disclose their negotiated rates with payers.

Researchers asked consumers to rate the ease or difficulty required to find, access and pay for care across 29 tasks, using an index of 1 to 200, with 200 being the "hardest" effort, 1 being "effortless" and anything above 100 being "difficult."

The result: Not one healthcare activity was described by consumers as effortless. Rather, consumers ranked the difficulty of dealing with the healthcare system as high as 149, and the average across all tasks at 117.

Avoiding care for various reasons was unfortunately something of a running theme in 2020. In April, West Health and Gallup found that roughly one in seven Americans say they would avoid seeking medical care if they experienced key symptoms associated with COVID-19 out of fear of the potential cost. When presented with a scenario in which they experience telltale signs of COVID-19, such as a fever and a dry cough, 14% of U.S. adults say they would avoid seeking medical attention due to cost. 

Even when asked to specifically suspect themselves infected with coronavirus, 9% would still avoid treatment, suggesting gaps in insurance coverage, poor finances or incomplete knowledge of the key symptoms of COVID-19.

Twitter: @JELagasse
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