Avoided Care Due to Cost in Delaware

Delaware

Health care prices are higher in the United States than in other countries. The Organization for Economic Co-operation and Development (OECD) estimates that the price of a visit to a family doctor in the U.S. is three times higher than in other G7 countries (a group of comparison countries consisting of Canada, France, Germany, Italy, Japan, the United Kingdom and the U.S.). The U.S. spends more on health care than any other country in the OECD, yet many are going without needed medical care because they cannot afford it. 

Avoiding or delaying needed health care has been associated with increased preventable hospitalizations 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 United States is projected to continue increasing through 2033. In 2022, the average American spent more than $14,000 on health care.

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

• Women compared with men.
• Adults ages 18-44, who have a prevalence more than four times higher than adults age 65 and older.
• Hispanic, American Indian/Alaska Native and Hawaiian/Pacific Islander adults compared with Asian and white adults.
• Adults with less than a high school education, who have a prevalence of avoiding care due to cost more than three times higher than that of college graduates.
• Adults with an annual household income less than $25,000, who have a prevalence nearly eight times higher than that of adults with incomes of $150,000 or more. As income level increases, the prevalence of avoiding care due to cost significantly decreases.
• Adults who have difficulty with cognition and adults with an independent living difficulty compared with adults who do not have a disability.
• LGBQ+ adults compared with straight adults.
• Adults who have not served in the U.S. armed forces compared with adults who have served. 

Additionally, 75% of adults ages 18-64 who were uninsured in 2025 said they skipped or postponed getting needed health care in the past year due to costs, compared with 37% of adults with health insurance. Even among those with health insurance, many adults are underinsured, meaning their coverage doesn’t allow affordable access to health care.

Multidisciplinary interventions that increase the affordability of health care by preventing disease and reducing out-of-pocket costs may reduce the proportion of adults who avoid care due to cost. Examples include expanding insurance coverage, transitioning to value-based payment models, advancing home-based care, improving the affordability of drugs and addressing health care workforce shortages. Primary care management also lowers costs by increasing continuity of care and reducing expensive emergency room and specialty care visits. The American Medical Association also recommends expanding Medicaid in more states and addressing physician shortages as strategies for improving access to health care.

Healthy People 2030 has multiple objectives related to health care access, including: 

• Reducing the proportion of adults who delay, avoid or cannot access necessary medical care due to cost.
• Increasing the proportion of adults who get recommended evidence-based preventive health care. 
• Increasing the proportion of people with health insurance.

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.

Bazemore, Andrew, Stephen Petterson, Lars E. Peterson, Richard Bruno, Yoonkyung Chung, and Robert L. Phillips. “Higher Primary Care Physician Continuity Is Associated With Lower Costs and Hospitalizations.” The Annals of Family Medicine 16, no. 6 (November 2018): 492–97. https://doi.org/10.1370/afm.2308.

Organization for Economic Co-operation and Development. Understanding Differences in Health Expenditure between the United States and OECD Countries. Policy Brief. Paris, France: OECD Publishing, September 20, 2022. https://doi.org/10.1787/6f24c128-en.

Pezzin, Liliana E., Hillary R. Bogner, Jibby E. Kurichi, Pui L. Kwong, Joel E. Streim, Dawei Xie, Ling Na, and Sean Hennessy. “Preventable Hospitalizations, Barriers to Care, and Disability.” Medicine 97, no. 19 (2018). https://doi.org/10.1097/MD.0000000000010691.

Shrank, William H., Nancy-Ann DeParle, Scott Gottlieb, Sachin H. Jain, Peter Orszag, Brian W. Powers, and Gail R. Wilensky. “Health Costs And Financing: Challenges And Strategies For A New Administration: Commentary Recommends Health Cost, Financing, and Other Priorities for a New US Administration.” Health Affairs 40, no. 2 (February 1, 2021): 235–42. https://doi.org/10.1377/hlthaff.2020.01560.

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 Value & Science-Driven Health Care Learning Health System Series. Washington, D.C.: National Academies Press, 2010.https://doi.org/10.17226/12750.