Avoided Care Due to Cost in United States

United States

The United States spends more on health care than any other country in the Organization for Economic Co-operation and Development (OECD). 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 child care or work schedules. 

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 2031. In 2022, the average American spent more than $13,000 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 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. The prevalence of avoiding care due to cost significantly decreases with each increase in education level.
• Adults with an annual household income less than $25,000, who have a prevalence more than four 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.
• Adults who have difficulty with cognition and adults with an independent living difficulty compared with adults without 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, adults ages 18-64 who are uninsured are more likely to have problems paying medical bills compared with adults who have 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 help reduce the proportion of adults who avoid care due to the cost. Examples include expanding insurance coverage, transitioning to value-based care, advancing home-based care, improving the affordability of drugs and developing a high-value workforce. Primary care management also lowers costs by increasing continuity of care and reducing expensive emergency room and specialty care visits. The American Medical Association recommends several strategies to improve access to health care, including expanding Medicaid in more states and addressing physician shortages.

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.

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

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 Evidence-Based Medicine. Washington, D.C.: National Academies Press, 2010. https://doi.org/10.17226/12750.