Top reason for delaying care is now cost, not COVID-19, patients say

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The end of the pandemic doesn't mean the end of deferred care, according to Cleveland Clinic physician and Qualtrics Chief Medical Officer Dr. Adrienne Boissy.

After two years of forgoing healthcare due to pandemic-related concerns, inflation is at an all-time high. Rising cost is the top reason Americans are deferring care, especially for mental health, nutrition and preventative care, according to Boissy.

"We're emerging to find the world is still different. The impact to people is long-lasting," Boissy said "We're still in it, but we're different now. What the pandemic brought to the forefront is how we show up in a community in a crisis. Affordability and accessibility are key tenets of communities."

What's necessary for patients to access care, she said, is listening and understanding.

"What organizations must do is listen differently about what patients and consumers expect from an access strategy," Boissy said. "We can't have digital channels that end in a dead end. We must create access where they are, in home, work and schools."

Patients have said they want telehealth as their preferred channel, Boissy said. One of the main reasons is cost.

"The cost is better all around," she said. "We're advocating for things like telehealth across state lines."

The American Medical Association has long expressed concern over physician burnout, which has been exacerbated by the pandemic. The AMA has looked at the clinician experience with telehealth and determined that physicians will continue to use it if it improves care for patients and reduces burnout, Boissy said.

Care needs to be seen as "not just in my building healthcare," she said. "I would love to see healthcare get more innovative about access."

Beyond telehealth and surveys, providers need to listen to patients, she said. "Empathy should be baked into processes. We have to consider different models of care. We have to listen to our communities. We advise hospital systems. Ease has to be an aspiration."

Delays and billing create a lot of pain for people, she said.

"Before we roll out digital strategies and automaton, look through the lens of people we're hoping to serve, their pain points," she said. "We don't need more dashboards, we need more action."

WHY THIS MATTERS

Qualtrics data shows that this year nearly a third of consumers, 31%, said they deferred healthcare, and more than a quarter, 26%, chose not to fill a prescription due to cost concerns. In 2020, at the height of the pandemic, a comparable 28% deferred care due to pandemic-related concerns. 

This study is the first one Qualtrics has done since the onset of the pandemic. 

Between 2020 and 2022, the share of consumers delaying care due to COVID-19 decreased about 11 percentage points, but the percentage of those putting off care because of cost increased by 4 points.

Forty-six percent said the cost of healthcare services and the cost of living were the most common reasons for delaying care. 

Over one-third, 36%, had taken on financial debt to pay for healthcare, which also leads to deferred care. Forty-three percent said they are unlikely to seek care if it means taking on debt. Combined with social determinants of health, this results in worse outcomes for patients, Boissy said.

Twelve percent cited lack of medical insurance. Over a quarter (26%) of consumers in the study chose not to fill a prescription in the past 12 months because of its cost.

Fifty-nine percent of patients said they wanted their healthcare experience to mirror that of a positive retail experience. In determining their loyalty to a healthcare provider, eight in 10 patients said customer service is the second most decisive factor, after quality of care. 

THE LARGER TREND

Qualtrics is an experience management company, with headquarters in both Seattle, Washington, and Provo, Utah. Earlier this month, the company announced that the Catholic health system Ascension had chosen Qualtrics for its patient-experience solutions.

Other surveys have shown similar results to those that Qualtrics found as far as the pressure of inflation on cost and care access.

The average cost for U.S. employers that pay for their employees' healthcare will increase 6.5%, to more than $13,800 per employee in 2023, largely due to economic inflation pressures, according to professional services firm Aon.

In June, a survey from Willis Towers Watson found that 40% of surveyed employees said they deferred medical care over the past year, including 28% who delayed or canceled a medical procedure or appointment. Another 17% failed to fill at least one prescription. When asked what prompted them to defer care, 25% said they couldn't afford it and 23% were unsure of the costs.

The survey also revealed that employees with significant difficulty paying for healthcare are more likely to suffer due to deferred care. Fifty-eight percent said their health suffered as a result.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org