Healthcare: Insurance Or Hindrance?

The high cost of healthcare in the US is a burden on families, and many people struggle to afford insurance coverage and care. This is particularly true for younger adults, those with lower incomes, adults in fair or poor health, and the uninsured. The cost of healthcare can lead people to put off seeking treatment, with 6 in 10 uninsured adults saying they have skipped or postponed getting healthcare due to the cost. The cost of prescription drugs also prevents some people from filling prescriptions, with 1 in 5 adults saying they have not filled a prescription because of the cost.

Uninsured people have lower access to care than insured people, and are more likely to delay or forgo care due to costs. They are less likely to receive preventive care and services for major health conditions and chronic diseases, and often face unaffordable medical bills when they do seek care. Uninsured nonelderly adults are nearly twice as likely as those with insurance to say they have difficulty affording healthcare costs.

The US healthcare system is expensive, complicated, dysfunctional, and broken. Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. The current system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost, contributing to avoidable healthcare disparities for people of colour and other disadvantaged groups.

Uninsured people have lower access to care than insured people

Access to care

People without insurance coverage have lower access to care than people who are insured. Those without insurance are more likely to delay or forgo care due to costs. Studies repeatedly demonstrate that uninsured people are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.

Preventive care and screening services

Uninsured people are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases. Uninsured adults are over three times more likely than insured adults to say they have not had a visit about their own health to a doctor or other health professional's office or clinic in the past 12 months. They are also less likely to receive recommended screening tests such as blood pressure checks, cholesterol checks, blood sugar screening, pap smear or mammogram (among women), and colon cancer screening.

Cancer care and outcomes

Uninsured cancer patients generally have poorer outcomes and are more likely to die prematurely than insured people, largely because of delayed diagnosis. Uninsured women and women with Medicaid are more likely to receive a breast cancer diagnosis at a late stage of disease (regional or distant) and have a 30–50% greater risk of dying than women with private coverage.

Chronic disease care and outcomes

Uninsured people with chronic diseases are less likely to receive appropriate care to manage their health conditions than are those who have health insurance. For the five disease conditions that were examined (diabetes, cardiovascular disease, end-stage renal disease, HIV infection, and mental illness), uninsured patients have worse clinical outcomes than insured patients.

Acute care services and outcomes for hospitalized adults

Uninsured patients who are hospitalized for a range of conditions experience higher rates of death in the hospital, receive fewer services, and are more likely to experience an adverse medical event due to negligence than are insured patients. Uninsured people are more likely to be admitted to a hospital that performs angiography or revascularization procedures, are less likely to receive these diagnostic and treatment procedures, and are more likely to die in the short term.

General health outcomes

Uninsured adults receive health care services that are less adequate and appropriate than those received by patients who have either public or private health insurance, and they have poorer clinical outcomes and poorer overall health than do adults with private health insurance.

Uninsured people are more likely to delay or forgo care due to costs

Uninsured adults are more likely to report problems getting needed medical care. One in five (20%) uninsured adults say that they went without needed care in the past year because of the cost compared to 3% of adults with private coverage and 8% of adults with public coverage. Many uninsured people do not obtain the treatments their health care providers recommend for them. In 2017, 19% of uninsured adults said they delayed or did not get a needed prescription drug due to cost, compared to 14% with public coverage and 6% with private coverage.

Uninsured people are far more likely than those with insurance to postpone health care or forgo it altogether. The consequences can be severe, particularly when preventable conditions or chronic diseases go undetected. Because uninsured people are less likely than those with insurance to have regular outpatient care, they are more likely to have negative health consequences. They are also less likely to receive necessary follow-up screenings than their insured counterparts, increasing their risk of being diagnosed at later stages of diseases, including cancer, and having higher mortality rates than those with insurance.

Uninsured children also face problems getting needed care. They are more likely to lack a usual source of care, to delay care, or to have unmet medical needs than children with insurance. Uninsured children with common childhood illnesses and injuries do not receive the same level of care as others and are at higher risk for preventable hospitalizations and missed diagnoses of serious health conditions.

Uninsured people are less likely to receive preventive care and services for major health conditions and chronic diseases

Uninsured people are less likely to have a regular source of care and are more likely to identify an emergency department as their usual source of care. They are also less likely to receive preventive and screening services, and less likely to receive these services on a timely basis. This is particularly true for relatively costly services, such as mammograms, than for less costly services, such as a clinical breast exam or Pap test. Uninsured people are also less likely to receive recommended screening services and are less likely to receive them at the frequencies recommended by the United States Preventive Services Task Force.

Uninsured people with chronic diseases are less likely to receive appropriate care to manage their health conditions. They are less likely to receive recommended services, and lacking health insurance for longer periods increases the risk of inadequate care for this condition and can lead to uncontrolled blood sugar levels, which, over time, put diabetics at risk for additional chronic disease and disability. Uninsured people with chronic conditions are also less likely to have a regular source of care and are more likely to identify an emergency department as their regular source of care.

Uninsured people with acute cardiovascular disease are less likely to be admitted to a hospital that performs angiography or revascularization procedures, are less likely to receive these diagnostic and treatment procedures, and are more likely to die in the short term. They are also less likely to receive routine screening services for cardiovascular disease and are less likely to stay on drug therapy for hypertension.

Uninsured people often face unaffordable medical bills when they seek care

In the US, nearly 44 million people are uninsured, and this number is rising. Many physicians are confronted with patients who cannot pay for the health care they need. When patients lack sufficient health insurance, financial matters become intertwined with biomedical considerations in the process of clinical decision-making. Clinicians may be compelled to bend billing or reimbursement rules, lower standards, or turn patients away when they cannot afford the costs of care.

The standard of care for uninsured patients is often lower than that of insured patients. For example, uninsured patients are less likely to receive preventive and screening services and are more likely to receive a late-stage diagnosis for invasive cervical cancer than those with private insurance. They also have a greater risk of dying prematurely than insured patients, largely due to delayed diagnoses.

The high cost of health care can lead some people to put off needed care. One in four adults say that in the past 12 months, they have skipped or postponed getting health care due to the cost. This includes six in ten uninsured adults (61%) who say they went without needed care because of the expense. Uninsured adults are more likely to be hospitalized for avoidable health problems and to experience declines in their overall health.

Uninsured individuals are also more likely to face negative consequences due to health care debt, such as using up savings, having difficulty paying other living expenses, or borrowing money. They may also have to make difficult sacrifices, such as eating less, changing their housing situation, or increasing their work hours to pay off their debt.

Uninsured people are more likely to have health care debt

The high cost of insurance is the main reason why many people lack health coverage. In 2022, 64% of nonelderly uninsured adults cited the high cost of coverage as the primary reason for their lack of insurance. Uninsured people often face unaffordable medical bills when they seek care, and these costs can quickly translate into medical debt since most uninsured people have low or moderate incomes and little to no savings.

A survey by KFF found that 41% of adults currently have some form of health care debt, with this figure rising to 57% when including those who have had medical debt in the past five years. Uninsured adults, women, Black and Hispanic adults, parents, and those with lower incomes are especially likely to have health care-related debt. Furthermore, 16% of adults have had debt due to medical or dental bills in the past five years that they have since paid off.

Uninsured individuals are more likely to delay or forgo care due to costs. They are less likely to receive preventive care and services for major health conditions and chronic diseases. This can lead to more serious health problems and higher mortality rates. Uninsured people are nearly twice as likely as those with insurance to report difficulty affording health care costs.

The consequences of health care debt can be severe and far-reaching. In addition to financial burdens, individuals may experience anxiety and worry, difficulty accessing future health care services, and a decline in their overall health. They may also be contacted by debt collectors, have their credit scores negatively affected, or face legal consequences such as being sued by a provider or declaring bankruptcy.

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