Avoided Care Due to Cost

Avoided Care Due to Cost in New York

New York

The United States spends more on health care than any other country in the Organization for Economic Co-operation and Development (OECD), yet provides fewer resources.

The high cost of health care in the U.S. is one of the major factors in avoiding needed care. Other barriers include inadequate or nonexistent insurance coverage, transportation issues, negative interactions with providers and care teams, delayed access and issues with childcare or work schedules. Lack of access to health care has long 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 2030. Currently, the average American spends more than $11,000 a year on health care.

Adults who are uninsured are more likely to have problems paying medical bills compared with adults who have health insurance. Even among insured adults, those enrolled in high-deductible health plans — plans that typically have lower monthly payments, but require beneficiaries to pay more health care costs themselves before insurance starts to pay its share — are nearly twice as likely to delay or entirely forgo care due to cost compared with adults enrolled in traditional health plans.

The prevalence of avoiding care due to cost is higher among:

• Women compared with men.
• Adults ages 18-44, who have a prevalence four times higher than adults ages 65 and older.
• Hispanic adults compared with Asian 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 five times higher than that of adults with an annual household income of $75,000 and above. As income level increases, the prevalence of avoiding care due to cost significantly decreases.

Multidisciplinary interventions that increase the affordability of health care by preventing disease and reducing out-of-pocket costs may have an impact on reducing the proportion of adults who avoid care due to the cost. Examples include:

• Patient-centered care and shared decision-making have been shown to reduce expenditures by increasing health education and empowering patients to choose cost-effective diagnostic tools and treatment options.
• Primary care management lowers costs by increasing continuity of care and reducing expensive emergency room and specialty care visits. 

Reducing the proportion of adults who delay, avoid or cannot access necessary medical care due to cost is a Healthy People 2030 objective. 

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