Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services

Background: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk...

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Main Authors: Kyle T. Smith, Denise Monti BA, Nageen Mir MPH, Ellen Peters PhD, Renuka Tipirneni MD, Mary C. Politi PhD
Format: Article
Language:English
Published: SAGE Publishing 2018-03-01
Series:MDM Policy & Practice
Online Access:https://doi.org/10.1177/2381468318760298
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spelling doaj-3c670d4ba31f4d2a84ca6b1b6b135d012020-11-25T03:13:24ZengSAGE PublishingMDM Policy & Practice2381-46832018-03-01310.1177/2381468318760298Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care ServicesKyle T. SmithDenise Monti BANageen Mir MPHEllen Peters PhDRenuka Tipirneni MDMary C. Politi PhDBackground: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk and completed a survey assessing demographic characteristics, financial toxicity, health care minimizer-maximizer tendencies, health insurance knowledge, numeracy, delaying/avoiding any care, and delaying/avoiding six common health care services (three preventive and three nonpreventive services). Validated measures were used when available. Delay/avoidance behaviors were categorized into delaying/avoiding any care, preventive care, and nonpreventive care. Logistic regression models examined 1) financial toxicity, 2) minimizer-maximizer tendencies, 3) numeracy, 4) health insurance knowledge, and 5) knowledge of preventive care coverage separately on three forms of delay/avoidance behaviors, controlling for chronic conditions, insurance status, and/or income where appropriate. Results: Of 518 respondents, 470 did not fail attention-check questions and were used in analyses. Forty-five percent of respondents reported delaying/avoiding care due to cost. Multivariable analyses found that financial toxicity was related to delaying/avoiding any care (odds ratio [OR] = 0.884, P < 0.001), preventive care (OR = 0.906, P < 0.001), and nonpreventive care (OR = 0.901, P < 0.001). A tendency to minimize seeking health care (OR = 0.734, P < 0.001) and lower subjective numeracy (OR = 0.794, P = 0.023) were related to delaying/avoiding any care. General health insurance knowledge (OR = 0.989, P = 0.023) and knowledge of preventive care coverage (OR = 0.422, P < 0.001) were related to delaying/avoiding preventive care. Conclusions: Many people delay or avoid health care due to costs, even when insured. Results suggest that there may be different reasons individuals delay or avoid preventive and nonpreventive care. Findings may inform interventions to educate consumers and support discussions about health care costs to facilitate appropriate health care utilization.https://doi.org/10.1177/2381468318760298
collection DOAJ
language English
format Article
sources DOAJ
author Kyle T. Smith
Denise Monti BA
Nageen Mir MPH
Ellen Peters PhD
Renuka Tipirneni MD
Mary C. Politi PhD
spellingShingle Kyle T. Smith
Denise Monti BA
Nageen Mir MPH
Ellen Peters PhD
Renuka Tipirneni MD
Mary C. Politi PhD
Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
MDM Policy & Practice
author_facet Kyle T. Smith
Denise Monti BA
Nageen Mir MPH
Ellen Peters PhD
Renuka Tipirneni MD
Mary C. Politi PhD
author_sort Kyle T. Smith
title Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
title_short Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
title_full Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
title_fullStr Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
title_full_unstemmed Access Is Necessary but Not Sufficient: Factors Influencing Delay and Avoidance of Health Care Services
title_sort access is necessary but not sufficient: factors influencing delay and avoidance of health care services
publisher SAGE Publishing
series MDM Policy & Practice
issn 2381-4683
publishDate 2018-03-01
description Background: Despite recently expanded access to health insurance, consumers still face barriers to using their coverage to obtain needed health care. Objective: To examine the characteristics of those who delay or avoid health care due to costs. Methods: Participants were recruited via Amazon MTurk and completed a survey assessing demographic characteristics, financial toxicity, health care minimizer-maximizer tendencies, health insurance knowledge, numeracy, delaying/avoiding any care, and delaying/avoiding six common health care services (three preventive and three nonpreventive services). Validated measures were used when available. Delay/avoidance behaviors were categorized into delaying/avoiding any care, preventive care, and nonpreventive care. Logistic regression models examined 1) financial toxicity, 2) minimizer-maximizer tendencies, 3) numeracy, 4) health insurance knowledge, and 5) knowledge of preventive care coverage separately on three forms of delay/avoidance behaviors, controlling for chronic conditions, insurance status, and/or income where appropriate. Results: Of 518 respondents, 470 did not fail attention-check questions and were used in analyses. Forty-five percent of respondents reported delaying/avoiding care due to cost. Multivariable analyses found that financial toxicity was related to delaying/avoiding any care (odds ratio [OR] = 0.884, P < 0.001), preventive care (OR = 0.906, P < 0.001), and nonpreventive care (OR = 0.901, P < 0.001). A tendency to minimize seeking health care (OR = 0.734, P < 0.001) and lower subjective numeracy (OR = 0.794, P = 0.023) were related to delaying/avoiding any care. General health insurance knowledge (OR = 0.989, P = 0.023) and knowledge of preventive care coverage (OR = 0.422, P < 0.001) were related to delaying/avoiding preventive care. Conclusions: Many people delay or avoid health care due to costs, even when insured. Results suggest that there may be different reasons individuals delay or avoid preventive and nonpreventive care. Findings may inform interventions to educate consumers and support discussions about health care costs to facilitate appropriate health care utilization.
url https://doi.org/10.1177/2381468318760298
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