Americans Are Delaying, Postponing Care, New Survey Shows

Janice Simmons, for HealthLeaders Media , April 22, 2009

In what has been felt throughout many healthcare organizations in recent months has been confirmed in a new survey: approximately 20% of Americans say they have delayed or postponed medical care—particularly physician visits—because of related costs, according to a new survey of 12,000 people nationwide from Thomson Reuters' Center for Healthcare Improvement.

"What is clear is that there is a substantial increase in stress on consumers on paying both for insurance and healthcare. Many said cost was the main reason," said study coauthor Gary Pickens, PhD, in an interview. The survey found that 21% of adults across the country expected to have difficulty paying for health insurance or services in the next three months.

Pickens noted that the recession has impacted the reasons why households may or may not have healthcare insurance between 2009 and 2006 (when an earlier survey was conducted). Although the same percentage of household reported making changes related to their healthcare coverage, the types of strategies were different--with an emphasis on cost-cutting in 2009. In 2006, the reasons were more likely to be related to not being eligible for insurance or waiting on insurance.

In 2006, lack of time for care was the reason most often cited by households for postponing care (cited by 26% of those surveyed), while cost was mentioned next (by 20%). But by 2009, cost (cited by about 24%) emerged at the top. "It's clear that at this point now that cost is the dominant reason," Pickens said.

For healthcare leaders, the picture does not appear to be changing much in the next three months—particularly when consumers' expectations are reviewed, Pickens noted. In particular, 28% of those surveyed said they were very likely to postpone or cancel elective surgical procedures, 13 percent would delay or cancel routine physician visits, 15% would delay or cancel therapy visits, and 17% would delay or cancel physician visits for minor illness or surgery. The visit least likely to be cancelled was healthcare treatment for a child.

Pickens and his colleagues also found the rate of households with employer-sponsored insurance declined to 54.6 percent in 2009 from 59 percent in early 2008. At the same time, those covered by Medicaid rose to 14.5 percent in 2009 from 11.9 percent in 2008.

Those households with higher incomes were far less likely to report troubles paying for health insurance: The lowest income household (with annual income less than $25,000) were five times more likely to report difficulties when compared with those in the highest income levels (above $100,000 annually). Those households with unemployed members reported difficulty paying for services (60%) than any other group—including retirees or those employed part-time.

The full report can be viewed at

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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