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Waiting to Feel Better: Survey Reveals Cost Delays Timely Care

10 minute read

Key Takeaways:

  • More than half of Americans (54 percent) have delayed medical care for themselves in the past 12 months because they could not afford it. The three most delayed types of care are dental/orthodontic work, eye care, and annual exams.

  • Among people who have delayed care in the past 12 months, 55 percent delayed dental/orthodontic work, 43 percent delayed eye care, and 30 percent delayed annual exams.

  • Nearly one-quarter of Americans (23 percent) have put off getting medical care for more than one year because they could not afford it. Among those whose household is living paycheck to paycheck or not making enough to get by, the rate of this extremely delayed care averages 36 percent.

  • Nearly half of Americans (49 percent) say their health tends to take a back seat to other financial obligations.

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Healthcare is an essential part of many Americans lives, and unfortunately, money can be a factor in whether or not they’re getting the medical attention they need. Earnin looked at the impact money has on taking care of oneself in a pair of September 2018 surveys. One was conducted online among over 2,000 U.S. adults by The Harris Poll on Earnin’s behalf, for the other, Earnin polled their users, many of which live paycheck to paycheck.

The dire financial wellness of most adults is bleeding into their actual wellness. Over half of Americans (54 percent) say they’ve delayed medical care for themselves in the last 12 months because they couldn’t afford it and almost a quarter of Americans (23 percent) have delayed medical care for over one year due to financial issues.

A info graphic showing a pill colored 54% white.  Text reads: "More than half of Americans have delayed medical care in the past 12 months because they could not afford it."

What Medical Care Are Americans Putting Off?

The Harris Poll/Earnin data showed the most commonly delayed types of medical care resulting from a lack of money are dental or orthodontic work (55 percent), eye care (43 percent), and annual exams (30 percent). If you’re healthy, delaying or even skipping your annual physical may not be a big deal, but delaying dental care can be especially costly. In 2017, emergency room dental visits cost $1.9 billion, according to the Agency for Healthcare Research and Quality.

While the rates of postponement are lower for kids, 10 percent of Americans with children under 18 have delayed medical care for a dependent or child because they could not afford it. Nationally, 5 percent of Americans – or 16.29 million – have delayed medical care for a dependent or child because they could not afford it. With each report of delayed care corresponding to at least one child/dependent and at most two people reporting delayed care for the same child/dependent implies finances resulted in delayed medical care for least 8.15 million children/dependents. If Americans delayed care for more than one child/dependent, or the average number of Americans reporting delaying care for the same child/dependent is fewer than two, then this number is even higher.

It’s not surprising that Americans with higher annual household incomes are less likely to delay care than those with lower incomes. Similarly, most categories that correlate with income such as age, education, and home ownership show similar trends.*

A bar chart showing the percentage who have delayed care in the past 12 months (magenta), and the percentage who have delayed care for more than a year (purple), by income category.

Why Americans Aren’t Getting Healthcare

With the yearly average cost of healthcare over $10,000 per person in the US, it’s not surprising that even small amounts of financial distress can limit a family’s ability to afford care, forcing many to prioritize expenses.

A Bankrate survey found that only 39 percent of Americans can cover an unexpected $1,000 expense with savings. The lack of an emergency fund can put you in a bind, and when you have to choose between your health and spending money, the decision can have substantial long-term negative benefits. The same Bankrate survey also found that 34 percent of Americans have endured a significant unexpected expense over the past year, revealing that out of pocket spending on unexpected expenses is not uncommon.

Student loan debt, credit card debt and personal loans continue to grow, according to CareerBuilder. As a result, many Americans carry some form of debt and struggle to have enough saved for a rainy day. That same survey found that 78 percent of US workers live paycheck to paycheck.

Something has to give, and unfortunately, it often seems to be healthcare. Nearly half of Americans (49 percent) say their health tends to take a back seat to other financial obligations, according to The Harris Poll/Earnin survey. When surveying new Earnin customers, we found they were just as likely to agree that their health tends to take a back seat to other financial obligations (49 percent).

There’s one time when people do seem to get medical care -- tax return time. Another 2018 study by JP Morgan Chase & Co. further reinforces this issue of deferring care, finding that consumers' spending on health care was significantly affected by cash flow dynamics since they immediately increased their total out-of-pocket health care spending by 60 percent in the week after receiving a tax refund.

There are also some startups offering other options including Plushcare, which provides convenient and cost-effective access to doctors through their platform. Both insured and uninsured customers can book appointments with a world-class doctor, get diagnosed and prescribed medication by phone, computer, or mobile app. As an increasingly affordable means of accessing care, they have experimented with a variety of packages to appeal to a range of Americans.  

PlushCare’s data indicates that cheaper care options lead to more proactive patients. Normally, the company’s uninsured customers can book appointments for $99. At this price, uninsured customers use Plushcare an average of 1.2 times a year, but those that opt to PlushCare’s subscription service ($9 a month for unlimited $35 appointments) average nearly 2.2 appointments per year.

The Big Picture

When surveying new Earnin customers, we found that their financial situation is broadly similar to most Americans with a few key differences. New Earnin customers are substantially more likely to report having been charged a late or overdraft fee in the past 12 months (37 percent as compared with 12 percent of Americans overall). Additionally, new Earnin customers wish there was an easy tool to help them with their finances (83 percent) at a higher rate than American overall (62 percent). Many also indicated that having enough money each month is a struggle for them (70 percent of new Earnin customers; 53 percent of Americans overall).

A series of bar charts showing the fraction of people who agree with the statement "I wish there was an easy way to manage my finances".

More broadly, Americans are looking for options and ways to manage their finances better. Two-thirds of employed Americans (67 percent) say they wish the timing of their paychecks aligned with when they have payments due.

Americans may be delaying more than just healthcare, but not being proactive and seeking treatment when ailments are manageable is leading to rapidly growing costs.Given that healthcare costs tend to rise faster than inflation, financial health is likely to continue shaping Americans’ ability to afford timely care for the foreseeable future.

Survey Methodology

The primary source of data about national rates comes from a survey conducted online within the United States by The Harris Poll on behalf of Earnin from September 4-6, 2018 among 2,015 U.S. adults ages 18 and older. This online survey is not based on a probability sample, and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact Peter Griffin, Economist – Earnin.

Additionally, this survey was reproduced and provided to a random sample of new Earnin customers from September 10-19, 2018 for the purpose of being able to compare new Earnin customers with Americans in general.

*Table summarizing categories correlated with income.

A table supporting the claim that "most categories that correlate with income such as age, education, and home ownership show similar trends".