Americans avoiding health care in pandemic over cost concerns

The COVID-19 pandemic has shifted Americans’ perceptions of health care, and not for the better, according to a new survey.

Nearly half of Americans say the pandemic has worsened their perceptions of the U.S. health care system, with many describing it as "broken" or "expensive," according to the West Health-Gallup survey released this week, the largest survey conducted on U.S. health care since the start of the COVID-19 pandemic.

The high price of health care was a major factor, with a staggering one-third of Americans intentionally delaying or declining medical care over cost concerns.

In the midst of a pandemic, 14% of people with COVID-19 symptoms reported that they didn't seek medical care because they worried they wouldn’t be able to afford it, a Gallup poll from April 2020 found.

In the new survey, nearly all sectors of society reported deep concerns about the health care system, including the insured and uninsured, wealthy and poor. The pandemic has also raised awareness of the unequal impact on Black, Hispanic and other non-white groups.

The survey found nearly three out of four Americans believe that their household pays too much for the quality of health care they receive, and an estimated 58 million U.S. adults find health care costs to be a major financial burden for their families.

One survey respondent, a white, Republican woman in her 60s, told researchers, "It's hard when you have three or four kids and you're trying to juggle the cost, and you're deciding should I go to the emergency clinic or can we wait another day."

Avoiding treatment due to rising costs is a problem facing both poorer and richer Americans. Around 34% of people with household incomes of less than $24,000 reported not seeking care in the prior three months due to cost. Twenty percent of people in high-income households (earning more than $120,000 annually) reported the same.

One in five U.S. adults reported they or a member of their household had a health problem worsen after postponing their medical care due to concerns about cost.

"Postponing care is only going to create higher costs in the long run," said Dr. Blythe Adamson, founder of Infectious Economics LLC and affiliate professor at the University of Washington. "If we’re detecting cancer later on, that patient will have worse outcomes and more expensive care."

The West Health-Gallup survey found that 60% of Americans reported the pandemic has made them more concerned about unequal access to quality health care services. Among Black Americans and Hispanic Americans, this concern was higher at three-fourths and two-thirds, respectively.

"We get brushed aside, African Americans, a lot of times," said one survey respondent, a Black, Democrat woman in her 40s. "Things that we say, we feel it gets brushed off, they're not really taking it seriously, like, oh, she's just complaining again or it's not serious, that kind of thing."

Essential workers, who have lower income on average, continue to face greater COVID-19 risks than those with higher-income, more Zoom-friendly jobs.

"We continue to see low-income workers having high COVID-19 exposure at their job and not having insurance," Adamson said. "These people are more likely to be hospitalized and thrown into bankruptcy."

While some Americans have benefited from expanded access to telemedicine, inequities remain.

While other countries have government-backed health care, the US still relies on a mix of public and private health care insurers, which can create confusion and unequal pricing, according to Adamson.

Plus, as Adamson pointed out, "There are still many low income people that don't have reliable internet, smartphones or computers that they can use in a telemedicine visit."

Collectively, the survey shows that the pandemic appears to have worsened people’s views on the U.S. health care system.

"What’s changed in people’s minds is value in health care. Are we really getting a good value for every dollar we’re spending on prevention, on treatments, on hospitalization in this system?" Adamson asked.

Many of the challenges of the existing health care system were exposed under the strain of the COVID-19 pandemic.

"Our current system is unsustainable, especially for the poor," Adamson said.

Nicholas Nissen, M.D., is an author, host of the "Brain Health with Dr. Nissen" podcast and a contributor to the ABC News Medical Unit.