Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic

Abstract

Importance: The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in the US health care system.

Objective: To estimate frequency of and reasons for reported forgone medical care from March to mid-July 2020 and examine characteristics of US adults who reported forgoing care.

Design, setting, and participants: This survey study used data from the second wave of the Johns Hopkins COVID-19 Civic Life and Public Health Survey, fielded from July 7 to July 22, 2020. Respondents included a national sample of 1337 individuals aged 18 years or older in the US who were part of National Opinion Research Center's AmeriSpeak Panel.

Exposures: The initial period of the COVID-19 pandemic in the US, defined as from March to mid-July 2020.

Main outcomes and measures: The primary outcomes were missed doses of prescription medications; forgone preventive and other general medical care, mental health care, and elective surgeries; forgone care for new severe health issues; and reasons for forgoing care.

Results: Of 1468 individuals who completed wave 1 of the Johns Hopkins COVID-19 Civic Life and Public Health Survey (70.4% completion rate), 1337 completed wave 2 (91.1% completion rate). The sample of respondents included 691 (52%) women, 840 non-Hispanic White individuals (63%), 160 non-Hispanic Black individuals (12%), and 223 Hispanic individuals (17%). The mean (SE) age of respondents was 48 (0.78) years. A total of 544 respondents (41%) forwent medical care from March through mid-July 2020. Among 1055 individuals (79%) who reported needing care, 544 (52%) reported forgoing care for any reason, 307 (29%) forwent care owing to fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, and 75 (7%) forwent care owing to financial concerns associated with the COVID-19 pandemic. Respondents who were unemployed, compared with those who were employed, forwent care more often (121 of 186 respondents [65%] vs 251 of 503 respondents [50%]; P = .01) and were more likely to attribute forgone care to fear of SARS-CoV-2 transmission (78 of 186 respondents [42%] vs 120 of 503 respondents [24%]; P = .002) and financial concerns (36 of 186 respondents [20%] vs 28 of 503 respondents [6%]; P = .001). Respondents lacking health insurance were more likely to attribute forgone care to financial concerns than respondents with Medicare or commercial coverage (19 of 88 respondents [22%] vs 32 of 768 respondents [4%]; P < .001). Frequency of and reasons for forgone care differed in some instances by race/ethnicity, socioeconomic status, age, and health status.

Conclusions and relevance: This survey study found a high frequency of forgone care among US adults from March to mid-July 2020. Policies to improve health care affordability and to reassure individuals that they can safely seek care may be necessary with surging COVID-19 case rates.

Figure 1.. Share of Respondents Forgoing Medical Care From March Through Mid-July 2020

Forgone medical care includes missing 1 or more doses of a medicine the respondent typically picked-up or had someone else pick-up from a retail pharmacy; missing a scheduled health care visit, including a preventive care visit, general medical outpatient visit, mental health outpatient visit, or elective surgical procedure; or not receiving care for a new severe (defined based on self-report as severity 4-5 on a scale of 1-5) physical or mental health issue. Individuals could report multiple types of forgone care during the period of March through mid-July 2020.

Figure 2.. Reasons Reported for Forgoing Care Among Respondents Who Missed Planned Care From March Through Mid-July 2020

Respondents were prompted to select the reasons that best described why they missed taking a dose(s) of medication or missed a previously scheduled health care appointment. Respondents were allowed to select more than 1 reason. Practitioner practice being closed was not a response option for individuals who reported missing a dose of prescription medication. COVID-19 indicates coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Figure 3.. Reasons Reported for Forgoing Planned Care Among Respondents Who Reported Needing Care by Employment and Health Insurance Status

Responses are based on the time period of March through mid-July 2020, during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in the United States. SARS-CoV-2 indicates severe acute respiratory syndrome coronavirus 2.