Frustrated young african american woman reading paper letter with bad news
Despite Congressional actions to reduce the out-of-pocket costs for insulin, medical costs continue to plague Americans. Four in ten Americans report difficulty paying for medical care and about half carry medical debt.
Now, new research shows that more Americans than ever are delaying care because of costs.
In the annual Gallup Health and Healthcare poll, released last week, 38% of Americans reported that they or a family member had delayed medical care in the prior 12 months because of cost. That figure represents a 12 point increase over last year, the highest in the 22 years Gallup has been tracking this figure.
Americans were even more likely to report delaying treatment for a serious condition than they were for a nonserious condition. More than one-quarter (27%) of those surveyed said that they or a family member had put off treatment for a very or somewhat serious condition. Just 11% delayed care due to cost for a less serious condition.
The increase in the number of people delaying care because of cost may result from a confluence of factors, according to Florian Otto, CEO of Cedar, a healthcare financial platform provider.
“The financial responsibility we place on patients today is higher than ever, [reaching nearly $500 billion],” Otto said. “At the same time, hospitals are working with average operating margins of less than 1%, and end up turning to extreme and ineffective ways of collecting payments, or absorbing bad debt.”
Though Gallup has previously found that a majority of U.S. adults report at least moderate financial hardships as a result of inflation, the impact of costs on consumers’ health-seeking behavior is uneven.
Nearly one-third (32%) of women reported putting off medical care because of cost, compared with 20% of men. These figures represent 12- and 5-point increases relative to the 2021 survey and the highest gender gap recorded in the survey since 2001.
Similarly, 34% of Americans who earned less than $40,000 in household income reported that they or a family member had delayed medical care for a serious condition because of cost. That figure was up 12 points and was nearly twice as high as the number of people earning $100,000 who had delayed care. But even among middle- and higher-income groups, the rates of people who reported delaying medical care was at their highest, or tied with the highest, levels in the history of this poll.
Younger adults were also more likely to report delaying care due to cost. Thirty-five percent of adults aged 18 to 49 said they or a family member had done so, compared with 25% of adults aged 50 to 65 and 13% of adults 65 and older.
Fear of medical bills can be well founded, especially for younger and lower-income consumers.
According to Cedar’s internal analysis of its own product data, 16% of patients on the platform with a bill over $1,000 live in zip codes with median incomes below $40,000. They also tend to be younger on average than patients who were able to pay large bills and patients with small bills.
Otto said that these patients likely have fewer financial resources to help with their healthcare bills. Even when they have insurance, Otto said, that insurance covers less of their bills compared to patients who are able to resolve their large medical bills. Patients with large outstanding bills also tend to go to the doctor more often and have more complex visits, their medical bills show.
“Despite having fewer resources, these patients are motivated to pay,” Otto said.
These patients are almost twice as likely to seek financial aid options, but they can’t always find a payment option that works for their financial situation, according to Otto.
The company interviewed patients who were carrying medical bill balances of $1,500 or more and identified an opportunity for healthcare providers to help patients learn about financial assistance and payment options.
But just letting patients know that payment options exist isn’t enough to reduce cost barriers to care.
“When providers do share financial assistance resources, such assistance can be difficult to receive due to complex processes and murky qualification criteria,” Otto said. “Because patients don’t know that they have options, they resort to feeling like they have to delay care.”
Otto said that Cedar’s research showed that patients with large medical bills can feel overwhelmed and need help to understand and navigate the options for resolving those bills.
“Patients who were able to learn about their options earlier had a much better chance of paying their bills—and got the care they needed sooner,” he said. “Patients want to pay their bills—and flexibility and empathy can go a long way in helping them.”
