1 in 4 patients delay care, cite healthcare affordability issues

Healthcare affordability challenges are more common than previously thought, with a new JAMA Internal Medicine report showing that, over a four-year period, nearly a quarter of patients struggled to afford their medical costs or skipped medical care altogether.

The data sheds new light on healthcare affordability by providing a longitudinal overview of patient experiences, as opposed to assessing healthcare affordability over a single-year period, the study authors said.

In other words, the four-year study period for this particular paper cast a wider net and was able to capture a potentially more accurate portrayal of the depth of healthcare affordability problems.

Healthcare affordability isn't a new issue, but it has become more salient. The insurgence of high-deductible health plans has left more patients on the hook for their medical costs, as have rising premium costs. At the same time, the cost of healthcare services has spiked, leaving out-of-pocket patient costs high.

Numerous studies have looked at the proportion of U.S. patients having trouble affording their healthcare, typically finding that it's not uncommon for individuals to struggle to pay their bills. These studies use any number of proxies to measure healthcare affordability challenges, including medical debt burden, subject measures of "trouble" paying for medical bills and number of times a patient has skipped or delayed care due to cost.

This latest study takes that a step further by looking at medical cost burdens over a four-year period, finding that the larger study period indicates a more pervasive healthcare affordability issue.

Using data from 2018 to 2022 from the Medical Expenditure Panel Surveys, the researchers measured the number of people facing cost burdens (defined as difficulty paying medical bills or high out-of-pocket costs) and catastrophic cost burdens (defined as a "severe" level of financial strain from healthcare costs).

In the short-term, 6.5% of adults faced a cost burden and 3.5% experienced a catastrophic cost burden.

But when opening that timeframe up to four years, the researchers found a more dire situation.

Over the four-year period, 17.4% of adults experienced a cost burden at least once, and 9.9% experienced a catastrophic cost burden. Nearly a quarter of all U.S. individuals lived in families with cost burdens, and 11.2% lived in families with catastrophic cost burdens.

Meanwhile, 26.7% of adults skipped care because of cost or because they'd previously experienced a financial burden from healthcare.

Individuals experiencing cost burdens were more likely to have lower incomes, be uninsured, have been hospitalized or manage a chronic disease. These factors compound risk for medical cost burdens, the researchers added.

The researchers also looked at medical cost burdens and mortality, finding that 53.2% of individuals who died during the study period experienced healthcare cost burdens in the 1-4 years before their death.

These study findings are important, as they indicate that medical cost burdens are more widespread and pervasive than originally thought. This is a problem unique to America, the researchers added, as multiple sources have pointed to higher cost burdens in the U.S. than in peer nations.

"Patients in the US bear more costs than patients in other nations, a difference that reflects policy choices, such as the use of high-deductible health plans to mitigate moral hazard and fragmented health financing and complex Medicaid eligibility requirements that lead to frequent coverage lapses," the researchers wrote in the study's conclusion.

"Abolishing price tags for care, as most other high-income nations have done, might enhance the financial welfare and health of individuals in the US."

Sara Heath has reported news related to patient engagement and health equity since 2015.