Avoided Care Due to Cost - Women

Avoided Care Due to Cost - Women in United States

United States

Many Americans experience challenges accessing and affording health care, particularly those in vulnerable populations. Approximately half of the women in the United States report that they have delayed necessary medical care, testing or treatment due to cost, at significantly higher rates than men. About 67% of women would be unable to pay for an unexpected $500 medical bill in full without going into debt; a quarter would not be able to pay it at all. 

The high cost of U.S. health care 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. Widespread lack of access to affordable, timely and high-quality health 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 U.S. health care is projected to continue increasing. Currently, the average American spends more than $12,000 a year on health care.

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

• Women ages 25-34 compared with those ages 35-44.
• Hispanic women compared with Asian women. 
• Women with less than a high school education compared with those with higher levels of education; college graduates have the lowest prevalence of avoiding care due to cost. 
• Women with an annual household income less than $25,000 compared with those with higher income levels.

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. A survey found that almost half of uninsured women received no or delayed care due to cost. Another study revealed that women with high-deductible health insurance plans are more likely to have delayed breast cancer screening.

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

Policy-level interventions that may make health care more affordable include expanding Medicaid and other coverage options for those who do not qualify for Medicaid (e.g., immigrants and individuals with incomes too high) and establishing affordability criteria for health insurance plans.

A Healthy People 2030 goal is to reduce the proportion of adults who delay or forgo needed medical care.

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Cosgrove, Delos M., Michael Fisher, Patricia Gabow, Gary Gottlieb, George C. Halvorson, Brent C. James, Gary S. Kaplan, et al. 2013. “Ten Strategies To Lower Costs, Improve Quality, And Engage Patients: The View From Leading Health System CEOs.” Health Affairs 32 (2): 321–27. https://doi.org/10.1377/hlthaff.2012.1074.

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.

Rust, George, Jiali Ye, Peter Baltrus, Elvan Daniels, Bamidele Adesunloye, and George Edward Fryer. 2008. “Practical Barriers to Timely Primary Care Access: Impact on Adult Use of Emergency Department Services.” Archives of Internal Medicine 168 (15): 1705. https://doi.org/10.1001/archinte.168.15.1705.

Wharam, J. Frank, Fang Zhang, Jamie Wallace, Christine Lu, Craig Earle, Stephen B. Soumerai, Larissa Nekhlyudov, and Dennis Ross-Degnan. 2019. “Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care.” Health Affairs 38 (3): 408–15. https://doi.org/10.1377/hlthaff.2018.05026.

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.