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Costs Force Americans to Skip Doctor Visits

Healthcare in the United States should be accessible to all, but this has not always been the case in recent years, especially since the 2020 COVID-19 pandemic. Fortunately, improvements are being made, and the U.S. has hit an all-time low in uninsured rates as of 2023, with 6.3 million people added to the health insurance rolls. Medical care can be costly for the 7.7% who carry no health insurance, forcing some to choose between medical treatment or other life necessities. Knowing the options and making wise decisions is essential for good health.

Delayed care, increased debt, and worsening health

The Federal Reserve System, whose primary function is to encourage efficient operations of the U.S. economy and protection of consumers through research and monitoring of issues and trends, provided new research on the state of healthcare and financial stability in the U.S. It found that 28% of all American adults., regardless of health insurance status, avoided medical care in 2022 due to cost.

When looking at the uninsured population, these statistics are higher, with 42% of the 7.7% of uninsured adults forgoing medical care. The most frequently neglected medical care among all insured and uninsured adults was dental visits in 2022 at 21%, followed by provider or specialist visits at 16%.

The Consumer Financial Protection Bureau (CFPB) found in 2021 that $88 billion in medical debt made up 58% of collections on credit reports, representing the most common debt among Americans in 2021. The CFPB also reports the impact of medical debt on physical and mental health and is considered a social determinant of health by many health professionals.

Studies have shown that delaying a medical visit or treatment has been known to worsen medical conditions and increase the risk of other diseases that could be preventable with appropriate care (Gertz et al., 2022; CDC, 2020). During the pandemic, many delayed or avoided care due to fear of COVID-19, causing some conditions to worsen in some individuals, and similar effects are found in those who avoid care due to costs.

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The value of healthcare

In the U.S., National Health Expenditures (NHE) grew 4.1% in 2022 for a total of $4.5 trillion or the equivalent of $13,493 per person, which is 17.3% of the Gross Domestic Product (GDP) and is expected to reach 19.6 percent by 2031 (CMS.gov, 2023). The U.S. spends more on healthcare than most nations, with the per capita health spending at $12,555 in 2022, while the average in other countries included in the OECD was $4,782, less than half of what is spent in America (OECD Statistics, 2023).

Healthcare spending by capital

Source: Organization for Economic Co-operation and Development. Health Statistics, 2023. https://stats.oecd.org/

Due to the Affordable Care Act (ACA), the number of Americans without insurance has dropped to record lows since 2001, with just 7.7% of U.S. citizens without health insurance in the first three months of 2023, or from 44 million in 2013 to 26.1 million in 2019. However, 29% of those with health insurance remained underinsured in 2019 (CDC, 2023b; HHS.gov). This is due to high premiums or uncovered costs preventing some from seeking the necessary care.

Despite the cost of healthcare and more Americans insured, some U.S. health indicators are lacking. The U.S. has a lower life expectancy than other nations in the OECD, and since 2019, the U.S. has seen a decline in life expectancy with a rise in healthcare spending (OECD Statistics, 2023).

In addition, according to Health.gov, several objectives for Healthy People 2030 show no improvements or are worsening. Examples of worsening objectives include the number of adults receiving preventive care, adolescents receiving preventive health visits, and pregnant women receiving adequate prenatal care. Conversely, several objectives have shown improvement, including reducing the number of people who can't get medical care when needed, increasing the number of people with health insurance, and increasing the number of individuals with prescription drug and dental insurance.

U.S Life expectancy

Source: Organization for Economic Co-operation and Development. Health Statistics, 2023. https://stats.oecd.org/

The good news

Today, more Americans are insured, and since the 2010 passage of the ACA, more Americans have access to care, more states have expanded Medicaid, and more funding has been provided to community health centers to deliver free care to improve preventive care (HHS.gov, 2022). Options are available to those underinsured or without insurance.

County health departments can provide information about your community's free health and vaccination clinics and other healthcare options. U.S. hospitals cannot deny care under federal law, but there are exceptions, such as a patient being medically unstable (intoxicated or having a mental health crisis) or reaching patient capacity.

Avoiding high costs and medical debt

You can take steps to prevent high medical costs or when you've incurred medical debt. Some states, such as New York, have strict medical debt collection and credit reporting laws, so be aware of what can and cannot be done in your state. If you live in a state that doesn't regulate medical debt and are uninsured or underinsured, the following can help avoid unforeseen circumstances.

To avoid high costs:

  • Establish a health savings account. A health savings account (HSA) is available to those with a high deductible health plan. It lets you set aside money to be used for qualified medical expenses. An HSA isn't taxed, and you can use the funds to pay deductibles, copayments, and other out-of-pocket expenses.
  • Early detection. Preventive screening can save exorbitant costs for future care. Early disease detection reduces the costs and resources needed for treatment.
  • Stay in your plan's network. Seeing providers in your plan's network can avoid many high costs. When it's not possible, speak with your insurance company about coverage. Some companies will work with the insured in extenuating circumstances.
  • Use virtual care. Virtual consultants reduce the cost of in-person visits for non-emergencies. Many urgent care visits can be handled virtually.
  • Avoid unnecessary tests and procedures. When your healthcare provider orders tests or procedures, ask questions to ensure they are essential to obtaining a diagnosis.
  • Request generic drugs. Generic drugs can save substantial dollars. Often, generic drugs can reap savings in the hundreds. For example, a generic EpiPen prescription can save $300–400 over the brand name.
  • Use prescription discounts. Good RX and other discount programs reduce the cost of prescriptions substantially. Your pharmacist can provide you with the best available discount for your drugs.
  • Take advantage of free clinics. Many U.S. communities offer free clinics to anyone, no questions asked. No matter what your insurance status, many clinics provide the same care you'd receive in a physician's office or urgent care facility.
  • Apply for emergency Medicaid. Even if you work, you may be eligible for temporary emergency Medicaid.

Once medical debt has been incurred:

  • Audit the bill. Ask for an itemized bill. Call the billing department if you've been charged for something you didn't receive. Billing errors do occur and can be costly.
  • Set up a payment plan. Hospitals are willing to work with patients to establish an affordable payment plan. Some states require the information to be on the backside of the bill or call your hospital's billing department.
  • Negotiate. Some healthcare facilities are willing to negotiate the cost based on income.
  • Avoid collection. If you don't work with your healthcare provider's billing department, they'll sell your bill to a collection agency. To avoid it, contact your provider right away to make repayment arrangements.
  • If a bill is in collections. Collection agencies buy debt from hospitals and other healthcare facilities at a fraction of what's owed, so you often can negotiate a lower price because the collection agency will still make money.

America is working to revamp its healthcare system so it's affordable for everyone. Lawmakers are working on new policies to prevent financial hardships. Also, the uninsured rate has reached all-time lows as of 2023, improving individuals' access to affordable and adequate health care.


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