Why Millions of Americans Skip Medical Care

 Kelly Emrick, MBA, Ph.D.

www.kellyemrick.com



In a nation renowned for its medical advancements, it's startling that many Americans forgo necessary healthcare due to cost concerns. In 2022, nearly 28% of American adults skipped some form of medical treatment because they couldn't afford it. Over the past decade, the percentage of adults avoiding medical care due to cost has fluctuated, but the issue remains pervasive. While there was an improvement from the 32% reported in 2013, the 2022 figure marks the third-highest year since data collection began. Income levels heavily influence the likelihood of skipping medical treatment:

  • 38% of individuals with a family income under $25,000 avoided medical care in 2022.
  • In contrast, only 11% of those earning $100,000 or more reported the same.

This disparity highlights the financial barriers that low-income families face when seeking essential health services. Health insurance plays a critical role in whether individuals seek medical care:

  • In 2022, 8% of Americans—approximately 26.4 million people—lacked health insurance.
  • Among adults aged 19 and older, 8.9% were uninsured.

Without insurance, unexpected medical expenses can be devastating. That same year, 23% of adults faced unforeseen medical bills ranging from $1,000 to $1,999. Furthermore, 16% reported accumulating debt due to medical expenses for themselves or family members. When costs become prohibitive, certain types of medical care are more likely to be skipped:

  1. Dental Care: A staggering 21% of adults avoided dental treatments, making it the most commonly skipped form of care.
  2. Doctor Visits: 16% skipped seeing a doctor or specialist.
  3. Prescription Medications: 10% did not fill or delayed filling prescriptions.
  4. Follow-up Care: Another 10% missed recommended follow-up treatments.
  5. Mental Health Services: 10% forewent mental health or counseling sessions.

These numbers underscore a troubling trend where preventive care and chronic condition management are neglected, potentially leading to more severe health issues down the line. Having health insurance significantly reduces the likelihood of skipping medical care:

  • 42% of uninsured adults skipped treatment due to cost concerns.
  • This contrasts with 26% of insured adults who did the same.


Uninsured individuals are also less likely to have a primary care provider, limiting their access to regular check-ups, preventive screenings, and timely interventions. The data paints a clear picture: cost remains a significant barrier to healthcare access for millions of Americans. Addressing this issue requires a multifaceted approach, including:

  • Policy Reforms: Implementing measures to reduce out-of-pocket costs and expand insurance coverage.
  • Community Programs: Enhancing support systems for low-income families to access affordable care.
  • Public Awareness: Educating individuals about available resources and preventive care benefits.

The increase in patients skipping medical care after 2018 can be attributed to several critical factors, including rising healthcare costs, changes in the insurance landscape, economic inequality, and the growing mental health crisis. Healthcare inflation, particularly in prescription drug prices and high-deductible health plans, made out-of-pocket expenses unaffordable for many Americans, particularly those with lower incomes. Political changes, such as repealing the individual mandate under the Affordable Care Act and expanding short-term, limited-duration health plans, further destabilized access to comprehensive insurance, resulting in higher uninsured rates. Wage stagnation, particularly for lower-income households and workers in the gig economy, made it harder for families to prioritize medical care. The COVID-19 pandemic exacerbated these issues, as fear, economic uncertainty, and disruptions to preventive care led to further delays in seeking treatment. Mental health services became increasingly in demand and were often inaccessible due to financial barriers and inadequate insurance coverage. Additionally, medical debt continued to rise, discouraging individuals from seeking further care. These intersecting factors have left many Americans without the ability to access necessary healthcare, particularly those from low-income households or rural areas, where access to care has become increasingly limited. Addressing these challenges requires policy reforms to expand insurance coverage, reduce out-of-pocket costs, and improve healthcare access, particularly for vulnerable populations.


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Reference Data:

Department of Health and Human Services. (2023). Health Coverage in the U.S. https://www.hhs.gov

Federal Reserve. (2023). Economic Well-Being of U.S. Households in 2022. https://www.federalreserve.gov

U.S. Census Bureau. (2023). American Community Survey. https://www.census.gov

 

 

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