Avoided Care Due to Cost - Ages 65+

Avoided Care Due to Cost - Ages 65+ in Florida

Florida

The high cost of health care in the U.S. is one of the leading factors in avoidance of care. Lack of health care access has long been associated with increased preventable hospitalizations and missed opportunities to prevent disease or manage chronic conditions, all of which can lead to worse and more expensive health outcomes. 

Health care expenses are often higher for older adults than younger adults. Although older adults are less likely to have difficulty paying medical bills than younger adults (due in part to Medicare coverage), out-of-pocket health care expenses are nearly twice as high among adults ages 65 and older compared with those ages 45-54. Older adults report difficulty affording services such as dental, vision and hearing that Medicare does not generally cover.

A study of adults ages 50 and older found that individuals with low health literacy reported delaying or forgoing needed medical care due to cost more often than those with adequate health literacy. Among adults ages 65 and older, those who were dually enrolled in Medicare and Medicaid and those with Medicare only were more likely to have problems paying their medical bills than those with Medicare Advantage or private coverage.

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

• Hispanic older adults compared with white older adults. American Indian/Alaska Native, Black and multiracial older adults also have a high prevalence. 
• Older adults with less than a high school education compared with those with higher levels of education; college graduates have the lowest prevalence.
• Older adults with an annual household income less than $25,000 compared with those with higher levels of income.

Interventions that reduce out-of-pocket costs and prevent disease may impact the proportion of older adults who avoid care due to cost. 

• Offering dental coverage through Medicare can reduce out-of-pocket costs for older adults and decrease the risk for developing costly medical conditions associated with poor oral health, such as heart disease, Type 2 diabetes and cerebral vascular disease. 
• Management of chronic conditions like high blood pressure, high cholesterol and diabetes is critical to preventing more severe illnesses, but it often involves costly long-term medications. Making medications more affordable has contributed to an increase in medication use, which has led to a decrease in the prevalence of cardiovascular disease. 

Because a lack of health literacy is associated with avoiding care due to cost, efforts to improve health information and services for older adults could also have an impact. There are many statewide programs that aim to improve health literacy. Examples include the North Carolina Program on Health Literacy (NCPHL), the Colorado Health Literacy Coalition (Colorado-HL) and Engage for Health, a Pennsylvania program that uses the Agency for Healthcare Research and Quality’s (AHRQ’s) “Questions are the Answer” patient engagement tools and resources (AHRQ-Tools).

Healthy People 2030 has an objective to reduce the proportion of people who cannot get medical care when needed.

Cha, Amy E., and Robin A. Cohen. 2020. “Problems Paying Medical Bills, 2018.” NCHS Data Brief No. 357. Hyattsville, MD: National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db357-h.pdf.

Cutler, David M., Kaushik Ghosh, Kassandra L. Messer, Trivellore E. Raghunathan, Susan T. Stewart, and Allison B. Rosen. 2019. “Explaining The Slowdown In Medical Spending Growth Among The Elderly, 1999–2012.” Health Affairs 38 (2): 222–29. https://doi.org/10.1377/hlthaff.2018.05372.

Jeffcoat, Marjorie K., Robert L. Jeffcoat, Patricia A. Gladowski, James B. Bramson, and Jerome J. Blum. 2014. “Impact of Periodontal Therapy on General Health: Evidence from Insurance Data for Five Systemic Conditions.” American Journal of Preventive Medicine 47 (2): 166–74. https://doi.org/10.1016/j.amepre.2014.04.001.

Levy, Helen, and Alex Janke. 2016. “Health Literacy and Access to Care.” Journal of Health Communication 21 (sup1): 43–50. https://doi.org/10.1080/10810730.2015.1131776.

Okoro, Catherine A., Tara W. Strine, Stacy L. Young, Lina S. Balluz, and Ali H. Mokdad. 2005. “Access to Health Care among Older Adults and Receipt of Preventive Services. Results from the Behavioral Risk Factor Surveillance System, 2002.” Preventive Medicine 40 (3): 337–43. https://doi.org/10.1016/j.ypmed.2004.06.009.

Rosano, Aldo, Christian Abo Loha, Roberto Falvo, Jouke van der Zee, Walter Ricciardi, Gabriella Guasticchi, and Antonio Giulio de Belvis. 2012. “The Relationship between Avoidable Hospitalization and Accessibility to Primary Care: A Systematic Review.” European Journal of Public Health 23 (3): 356–60. https://doi.org/10.1093/eurpub/cks053.

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