Avoided Care Due to Cost - Women in United States

United States

The high cost of health care in the United States is the primary reason cited for avoiding needed care. In 2023, approximately 28% of all American women reported that they have skipped or postponed getting health care they needed because of the cost — a rate 1.3 times higher than men. In a 2022 survey, 59% of women in the U.S. said they would not be able to pay an unexpected $500 medical bill in full without going into debt, and of those, 19% would not be able to pay it at all. 

Other barriers to accessing health care 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 2023, the U.S. spent an average of $14,570 per person on health care, totaling $4.9 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 and 18-24.
• Hispanic women, who have a prevalence 2.6 times higher than Asian women.
• Women with less than a high school education compared with college graduates. 
• Women with an annual household income less than $25,000, who have a prevalence nearly four times that of women with incomes of $75,000 or more. 
• Women who have any one of six disabilities compared with women without a disability.
• LGBQ+ women compared with straight women.

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 31, 2023. https://doi.org/10.26099/8ejy-yc74.

Kao, Yu-Hsiang, Wei-Ting Lin, Wan-Hsuan Chen, Shiao-Chi Wu, and Tung-Sung Tseng. “Continuity of Outpatient Care and Avoidable Hospitalization: A Systematic Review.” The American Journal of Managed Care 25, no. 4 (April 1, 2019): e126–34. https://www.ajmc.com/view/continuity-of-outpatient-care-and-avoidable-hospitalization-a-systematic-review.

Wharam, J. Frank, Fang Zhang, Jamie Wallace, Christine Lu, Craig Earle, Stephen B. Soumerai, Larissa Nekhlyudov, and Dennis Ross-Degnan. “Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care.” Health Affairs 38, no. 3 (March 1, 2019): 408–15. https://doi.org/10.1377/hlthaff.2018.05026.

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.