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Why don't patients access preventive care, screenings?
Patients aren't accessing preventive care and cancer screenings due to logistical barriers, like getting time off work and getting timely appointments.
The barriers to preventive care access run the gamut of logistical issues to fear and distrust, as the U.S. faces an alarming rate of foregone or delayed care, according to an Aflac survey.
The "Wellness Matters Survey," based on a nationally representative sample of 2,000 employed adults ages 18-65, revealed that nearly 90% have delayed getting a checkup or routine preventive screening.
This comes as incidence of cancer, especially among young people, continues to grow, the company said. Preventive screenings are important because they enable early detection of disease, which can improve prognosis and promote an overall culture toward well-being, according to Tom Morey, the senior vice president and chief actuary at Aflac.
"My personal experiences bring a clear focus on the concerning uptick, as our study reveals, in the number of Americans who may not be on a path to good health. Many avoid going to the doctor instead of doing what they can to avoid a health scare or detect a problem early," Morey said in a press release.
"It starts with making preventive care a priority and taking steps toward establishing a trusted relationship with a primary care doctor," Morey continued. "Personally, this helped me to feel more confident, more in control of my health and more empowered to deal with an illness that, otherwise, may have gone undetected."
Which preventive screenings do patients put off the most?
Many experts are worried about cancer screenings rates due to the serious and time-sensitive nature of cancer treatment. However, the Aflac survey also flagged a number of other preventive tests that patients are delaying. In all, the most commonly missed screenings include the following:
- Pap smear (33%).
- Prostate exam (32%).
- Colonoscopy (32%).
- Mammogram (31%).
- Blood test (31%).
- Full body skin cancer exam (27%).
- STD screening (22%).
Millennials are the most likely to skip any of these preventive services, with 62% reporting as much. A similar proportion (61%) of Gen Z likewise reported missing these screenings overall.
What keeps patients from getting preventive screenings?
According to Aflac, the issues keeping patients from their scheduled preventive screenings range from logistical to emotional.
For example, around a third of Gen Z patients (32%) said they feel embarrassed when visiting the doctor, or feel a distrust or dislike for the doctor. Similarly, a quarter of young women said they feel embarrassed while visiting the doctor or have a general fear of receiving bad news.
For other patients, logistics get in the way. Around half (48%) of respondents said factors like conflicting work schedules or having to take time off from work to attend an appointment is burdensome. Another 40% said they've canceled or not scheduled a doctor's appointment because the wait was too long.
There's a possible cognitive dissonance happening here, the survey authors said. Although patients know it is important to access primary and preventive care, their behavior does not match that intention. For most (65%), it takes a significant health scare to compel patients to begin prioritizing preventive care.
Still, there's some complex behavioral economics at play here, as the data shows individuals who think they might receive a cancer diagnosis are also among those most likely to skip a screening. Just under two-thirds (62%) of those anticipating a cancer diagnosis said they skip their screenings, compared to just 42% who said they didn't expect a cancer diagnosis.
The Aflac survey underscored some gender differences, particularly noting that younger women are more likely to skip care than their male counterparts. This is true for Gen Z, Millennials and Gen X.
This trend could stem from a number of issues. Women are less confident in their ability to control their physical and mental health than men. Similarly, they face greater financial burdens in accessing healthcare, the survey authors said.
Most adults don't have a usual source of care
Part of the preventive care roadblock is the large number of U.S. adults who do not have a usual source care or, more specifically, a primary care provider. According to the survey, a fifth of adults don't have a primary care physician, despite the fact that having a usual source of care increases the odds a patient will access recommended preventive screens.
Instead, patients are utilizing urgent care and the emergency room to treat more acute illness, indicative of a more reactive approach to healthcare. About two-fifths (41%) of adults, and nearly half of Gen Z and Millennials, reported that they mostly use urgent care or the emergency room to fulfill their medical needs. This trend was more pronounced in Men, Black people, Asian people and Hispanic people.
It's not just the preferred care site that's changing, the survey added. People, and especially young people, are turning to unconventional sources for health information.
Just over two-thirds (68%) of adults said they'd be open to consulting with a generative AI chatbot for medical advice, for example.
Community-based public health messaging effective
Community-based public health messaging could be an effective strategy to compel certain populations to access preventive care. Particularly, racial and ethnic minorities are often swayed by the encouragement and personal testimonies of their friends and families.
For example, 86% of Hispanic men said the urging of a loved one pushes them to get a preventive screening, the survey showed. This was also true for 84% of Black women and 83% of Hispanic women. Overall, men were more likely swayed by loved ones than their female peers.
Moreover, 24% of survey respondents said someone in their family urged them to get a preventive screening.
"Having a 'we are in this together' approach to our health may lead to better outcomes for Americans, their families and loved ones," Morey explained. "One way to advocate is to schedule preventive care appointments together, at the same time. Our survey shows that Americans who book health appointments at a specific time of year are twice as likely to follow through with recommended checkups and screenings."
Sara Heath as reported news related to patient engagement and health equity since 2015.
