Kyle T. Smith|Denise Monti|Nageen Mir|Ellen Peters|Renuka Tipirneni|Mary C. Politi
Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
Washington University in St. Louis|Washington University in St. Louis|Washington University in St. Louis|The Ohio State University|University of Michigan–Ann Arbor|Washington University in St. Louis
background despite recently expanded access health insurance consumers still face barriers using coverage obtain needed health care objective examine characteristics delay avoid health care due costs methods participants recruited via amazon mturk completed survey assessing demographic characteristics financial toxicity health care minimizermaximizer tendencies health insurance knowledge numeracy delayingavoiding care delayingavoiding six common health care services three preventive three nonpreventive services validated measures used available delayavoidance behaviors categorized delayingavoiding care preventive care nonpreventive care logistic regression models examined 1 financial toxicity 2 minimizermaximizer tendencies 3 numeracy 4 health insurance knowledge 5 knowledge preventive care coverage separately three forms delayavoidance behaviors controlling chronic conditions insurance status andor income appropriate results 518 respondents 470 fail attentioncheck questions used analyses fortyfive percent respondents reported delayingavoiding care due cost multivariable analyses found financial toxicity related delayingavoiding care odds ratio 0884 p 0001 preventive care 0906 p 0001 nonpreventive care 0901 p 0001 tendency minimize seeking health care 0734 p 0001 lower subjective numeracy 0794 p 0023 related delayingavoiding care general health insurance knowledge 0989 p 0023 knowledge preventive care coverage 0422 p 0001 related delayingavoiding preventive care conclusions many people delay avoid health care due costs even insured results suggest may different reasons individuals delay avoid preventive nonpreventive care findings may inform interventions educate consumers support discussions health care costs facilitate appropriate health care utilization