Avoided Care Due to Cost - Women in North Dakota

North Dakota

Many Americans experience challenges in accessing and affording health care. The high cost of health care in the United States is one of the primary reasons cited for avoiding needed care. In 2022, approximately half of all American women reported that they delayed necessary medical care, testing or treatment due to cost – a rate 1.5 times higher than men. In addition, about 57% of women said they could not pay an unexpected $500 medical bill in full without going into debt, and 23% would not be able to pay it at all. 

Other barriers include transportation issues, difficulty with child care and work schedules, inadequate or nonexistent insurance coverage and negative past experiences with or delays in accessing providers and care teams. Widespread lack of access to affordable, timely and high-quality primary care is associated with increased preventable hospitalizations, excess strain on emergency services 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 health care in the U.S. is projected to continue increasing. In 2022, Americans spent an average of $13,493 on health care, totaling $4.5 trillion across the nation.

According to America’s Health Rankings analysis, the prevalence of avoiding care due to cost is higher among:

• Women ages 25-34 compared with those ages 35-44.
• Women who identify their race as other and Hispanic women compared with Asian women. 
• Women with less than a high school education compared with college graduates. 
• Women with an annual household income less than $25,000 compared with those who have incomes of $75,000 or more.
• Women who have difficulty with self-care compared with women without a disability.
• LGBQ+ women compared with straight women.

Adults who are uninsured or underinsured are more likely to delay or entirely avoid care due to cost compared with adults who are adequately insured. Recent survey data found that 6 in 10 uninsured adults went without needed care in the past 12 months because they could not afford it, and additional research shows that women with high-deductible health insurance plans are more likely to have delayed breast cancer screenings. 

Multidisciplinary interventions that increase the affordability of health care by reducing out-of-pocket costs and preventing disease may reduce the proportion of adults who avoid care due to cost. Patient-centered care has also reduced the cost of care by empowering and educating patients to choose cost-effective diagnostic tools and treatment options.

Healthy People 2030 has an objective to reduce the proportion of people who delay or forgo needed medical care.

“2021 National Healthcare Quality and Disparities Report.” Rockville, MD: Agency for Healthcare Research and Quality, December 2021. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr.pdf.

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Cosgrove, Delos M., Michael Fisher, Patricia Gabow, Gary Gottlieb, George C. Halvorson, Brent C. James, Gary S. Kaplan, et al. “Ten Strategies To Lower Costs, Improve Quality, And Engage Patients: The View From Leading Health System CEOs.” Health Affairs 32, no. 2 (February 2013): 321–27. https://doi.org/10.1377/hlthaff.2012.1074.

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Gunja, Munira Z., Evan D. Gumas, and Reginald D. Williams II. “U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes.” Issue Brief. The Commonwealth Fund, January 2023. https://doi.org/10.26099/8ejy-yc74.

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Lowry, Elise, Annaliese Johnson, Amanda Hunt, and Tad Lee. “States Hold Keys To Health Care Affordability, But Are They Using Them?” Health Affairs Forefront, February 8, 2022. https://doi.org/10.1377/forefront.20220204.765285.

Yong, Pierre L., Robert S. Saunders, and LeighAnne Olsen, eds. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Institute of Medicine Roundtable on Evidence-Based Medicine. Washington, D.C.: National Academies Press, 2010. https://doi.org/10.17226/12750.