Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services

Abstract

Background: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk and completed a survey assessing demographic characteristics, financial toxicity, health care minimizer-maximizer tendencies, health insurance knowledge, numeracy, delaying/avoiding any care, and delaying/avoiding six common health care services (three preventive and three nonpreventive services). Validated measures were used when available. Delay/avoidance behaviors were categorized into delaying/avoiding any care, preventive care, and nonpreventive care. Logistic regression models examined 1) financial toxicity, 2) minimizer-maximizer tendencies, 3) numeracy, 4) health insurance knowledge, and 5) knowledge of preventive care coverage separately on three forms of delay/avoidance behaviors, controlling for chronic conditions, insurance status, and/or income where appropriate. Results: Of 518 respondents, 470 did not fail attention-check questions and were used in analyses. Forty-five percent of respondents reported delaying/avoiding care due to cost. Multivariable analyses found that financial toxicity was related to delaying/avoiding any care (odds ratio [OR] = 0.884, P < 0.001), preventive care (OR = 0.906, P < 0.001), and nonpreventive care (OR = 0.901, P < 0.001). A tendency to minimize seeking health care (OR = 0.734, P < 0.001) and lower subjective numeracy (OR = 0.794, P = 0.023) were related to delaying/avoiding any care. General health insurance knowledge (OR = 0.989, P = 0.023) and knowledge of preventive care coverage (OR = 0.422, P < 0.001) were related to delaying/avoiding preventive care. Conclusions: Many people delay or avoid health care due to costs, even when insured. Results suggest that there may be different reasons individuals delay or avoid preventive and nonpreventive care. Findings may inform interventions to educate consumers and support discussions about health care costs to facilitate appropriate health care utilization.

Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa

“…Our analysis also excludes respondents who may have avoided the medical system altogether even when it was necessary. US-based studies suggest that individuals may avoid medical care when there are barriers to access—even when they are insured [41], and the same is likely to be true in African setting. Distrust in the medical profession may also decrease one’s willingness to seek care [42].…”

Health seeking behaviour and its determinants in urban areas of developing countries: A primary survey in Kolkata city, India

“…Demand side factor like social backwardness and supply side factor like indirect costs discouraged the people to be more serious about their health. Several studies supported that increased healthcare cost and lack of awareness are barriers to access healthcare timely 59,60 . However, more man‐day loss (converted in terms of money) increase the probability of seriousness about treatment due to increased opportunity cost.…”

“…Several studies supported that increased healthcare cost and lack of awareness are barriers to access healthcare timely. 59,60 However, more man-day loss (converted in terms of money) increase the probability of seriousness about treatment due to increased opportunity cost. Patients with more travel time are more prone to be serious about treatment to avoid repeated visits.…”

Improving Cancer Patients’ Insurance Choices (I Can PIC): A Randomized Trial of a Personalized Health Insurance Decision Aid

“…Delay or avoidance of care because of cost was assessed via eight questions adapted from a previous study [35]. Each question asked if participants had delayed or avoided a specific health care service because of cost in the previous 3-6 months, such as a follow-up visit with their oncologist or prescription drugs for themselves or their family.…”