Cost Concerns Would Prevent Millions of Americans From Seeking COVID-19 Care, Survey Finds

April 28, 2020
Gianna Melillo

Gianna is an assistant editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.

A new Gallup poll found that 1 of 7 Americans (14%) reported they would avoid seeking healthcare for a fever and dry cough—common symptoms of the coronavirus disease 2019 (COVID-19)—for themselves or a family member due to cost concerns. Totaled, this percentage amounts to millions of Americans.

A new Gallup poll found that 1 of 7 Americans (14%) reported they would avoid seeking healthcare for a fever and dry cough—common symptoms of the coronavirus disease 2019 (COVID-19)—for themselves or a family member due to cost concerns. Totaled, this percentage amounts to millions of Americans.

Data showed the groups most likely to avoid seeking care due to cost were adults under 30 years, nonwhite individuals, individuals with a high school education or less, and those residing in households with incomes under $40,000 per year.

The survey was conducted via telephone interviews with adults 18 years and older living in the United States between April 1 and April 14. The investigators noted margins of error ranging from 2.0 to 3.7 percentage points for results based on the entire sample and 4 to 7 percentage points for most reported subgroups.

Of the 1107 randomly sampled adults surveyed, 9% reported they would still avoid seeking care even if they explicitly believed they were infected with COVID-19.

This finding suggests that misunderstanding of COVID-19’s primary symptoms may play a role when it comes to patients seeking care. Compounding this issue, the CDC recently added new symptoms to the list of possible COVID-19 signs, including chills, sore throat, muscle pain, new loss of taste or smell, and headache.

Gallup researchers point out that Hispanic and Black Americans are less likely to have health insurance than white Americans, and lower-income individuals are more likely to consider cost when doctors recommend medicine or procedures. Data also show that nonwhite populations are the cohorts disproportionately suffering from the COVID-19 pandemic.

The poll found that 6% of respondents (representing 15 million Americans) “report that they or a family member have been denied care due to heavy patient volume brought on from the coronavirus outbreak.”

According to the data, denial of care did not strongly relate to race. However, income level was inversely related to care being denied. “While 3% of those with annual household incomes exceeding $100,000 report such occurrences, this jumps to 11% of those with incomes of under $40,000—nearly 4 times higher,” researchers said.

This trend varied by geographic location, as individuals in the Northeast were more likely to report denied care (11%), followed by those in the West (8%), South (5%), and Midwest (3%) regions of the country. The virus’ epicenter is currently in New York and New Jersey, where increased volumes of patients in hospitals may explain higher care denial rates.

The survey results point to a larger issue facing everyday Americans: often unaffordable costs of healthcare in general. “A pretty substantial chunk of the population could remain hidden from view because of the US healthcare cost crisis,” said Dan Witters, the poll’s research director.

In addition, “Recent research has shown that millions of Americans know someone who has died in the last 12 months due to their inability to pay for treatment and that $88 billion in borrowing occurred over the last year for healthcare,” according to Gallup. Since 2017, 66% of US adults report prescription drug price increases.

Unemployment

Current US statistics show that 26.5 million Americans have filed for unemployment since mid-March, while a separate survey indicates an additional 8.9 to 13.9 million individuals may have been shut out of the system. As more and more individuals lose their jobs and health insurance as a result of the pandemic, concerns regarding cost of care may follow.

Increased testing, even for asymptomatic individuals, is a necessary prerequisite for reopening the US economy, the Gallup report argues. Statistics show the United States currently ranks 41st in the world for completed tests, as around 17,000 tests have been completed per every million persons.

The passage of the Families First Coronavirus Response Act aimed to address cost concerns held by millions of Americans. Insurance companies have agreed to waive co-pays for COVID-19 testing, but emergency department visits or hospital stays can still cost individuals thousands of dollars.

“If the doctor consulted determines that the [hospital] visit does not justify a test, or is out-of-network, or if the trip requires treatment for other conditions not related to COVID-19, the health law does not cover the costs of the visit,” Witters said.

Although minority populations are bearing the brunt of the COVID-19 pandemic, these cohorts face additional challenges when it comes to maintaining economic stability throughout the pandemic.

“Black and Latino Americans have less ability to withstand a prolonged job loss than whites, because they entered the crisis with lower incomes and less wealth. The median black household had just under $18,000 in wealth in 2016, Federal Reserve statistics show, while the median Hispanic household had just under $21,000. The median white household had nearly 10 times more: $171,000,” The New York Times reports.