A research study conducted by Harvard T.H. Chan School of Public Health, the Robert Wood Johnson Foundation, and the National Public Radio found that one in five adults in the U.S.—roughly 20%—reported that their household members delayed receiving medical care or were unable to get care at all. The December study was published in JAMA Health Forum.
“We were really shocked," Mary Gorski Findling, PhD, lead study author and senior research specialist at the Harvard T.H. Chan School of Public Health, tells Verywell. “It was much higher than we expected. It’s concerning when we ask people, why aren’t you getting care? People are saying their doctor’s office wouldn’t see them, canceled their appointments, or they don’t feel safe there.”
Consequences of Delayed Care
Of those who reported receiving delayed care, 57% said they experienced negative health consequences. Although the exact health consequences are unknown, delayed care can result in the patient becoming severely ill or worsening their prognosis, according to Nickolas Garbis, MD, an orthopedic surgeon at Loyola University Medical Center in Illinois. “By delaying care, people could experience serious illness,” Garbis tells Verywell.
Waiting to receive treatment can be especially detrimental financially. A patient who becomes more ill due to delayed care can have longer hospital stays and higher costs.
Researchers found that there are generally three stages of delay in seeking care:
Appraisal delay: the time it takes for the patient to notice symptoms as a sign of illnessIllness delay: the time taken for one to decide whether one is illUtilization delay: the time from the decision to seek care until the patient goes to the clinic to utilize services
“We found that a majority of households who have people with chronic conditions also reported cutting back on care,” Findling says. “Those conditions really need to be managed on an ongoing basis.”
Delayed care has also impacted those seeking elective surgeries—procedures that can be scheduled in advance. One in seven adults reported that household members delayed or were unable to get an elective procedure, with 54% reporting that they experienced a negative health consequence because of it.
“If you’re doing a hip or shoulder replacement, the arthritis can get worse and make the surgery more technically difficult with higher risk of complication,” Garbis says.
Barriers to Care
Generally, delayed care is usually caused by cost issues or health insurance problems. However, during the pandemic, nonfinancial reasons for delaying care seemed to be more prevalent. Only four in 10 people reported experiencing financial barriers to seeking care such as not being able to afford services or finding a physician that would accept their insurance.
Meanwhile, 69% of survey respondents reported nonfinancial access barriers, which included difficulty in:
Securing an appointment Finding a physician who would see them Accessing the location where care would be provided
Doctors like Garbis had to make some tough calls on what surgeries to prioritize. “A lot of the burden fell on the individual provider to decide where that line was, and what was important,” Garbis says.
Garbis found that testing positive for COVID-19 was also a significant barrier for some patients slated for surgery. “I’ve had patients with positive COVID-19 tests, who couldn’t get the operation,” Garbis says. “It might lead them to wait a little longer before actually coming to the doctor.”
Overall, the fear of COVID-19 exposure kept many away from procedures and appointments this past year. “Some patients delay their own care because they don’t want to be exposed to COVID-19 [in a] hospital or medical facility,” Garbis says. “My elderly patients are much more nervous coming to the hospital.”
In order to encourage patients to seek out care, communication about safety protocols between the physician and patient is key. Garbis says that using telehealth and remote services might help combat delayed care. Once a doctor makes a diagnosis online, they can then reiterate the COVID-19 safety procedures so care is not further delayed. “You will probably need COVID-19 testing around the time of any procedure and surgery,” Garbis says.
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