By Timothy Huzar

May 8, 2020

New research conducted by the analytics firm Gallup and the nonprofit organization West Health has found 1 in 7 people in the U.S. would avoid seeking treatment for the key symptoms of COVID-19 because of concerns over cost.

The study shines a light on the U.S. healthcare system and the barriers it places on people with low incomes from accessing healthcare.

In the U.S., healthcare is generally not paid for by the state but by the individual, typically through the health insurance that many people access as a benefit of employment.

However, those out of work or working on precarious contracts may not have access to health insurance. This makes them vulnerable to significant charges if they do require healthcare.

In the context of the COVID-19 pandemic, this situation has become even starker.

According to the research, while insurance companies have agreed to waive any additional payments related to COVID-19 testing, people could still end up with out-of-pocket expenses.

Gallup conducted a representative poll of 1,017 adults, asking them two questions. The first question was, “[i]f you or a family member had a fever and a dry cough, would you avoid seeking treatment due to concerns about the cost of care?”

The second question was “[i]f you thought that you might have been infected by the coronavirus, would you avoid seeking treatment due to concerns about the cost of care?”

Gallup found that 1 in 7 people — 14% of those polled — would avoid seeking treatment if they experienced a dry cough and fever.

When the question changed to ask the respondents directly about suspected COVID-19, Gallup found that 9% of people would still avoid seeking health care due to concerns over cost.

The researchers think that uncertainty surrounding the key symptoms of COVID-19 could account for the difference between the two questions. This was evident particularly in the 18–29 year age group in which 22% would avoid care due to costs for the two key symptoms, but only 12% would avoid care when coronavirus was specifically mentioned.

Unsurprisingly, for both questions, a person’s income was a key factor in whether they would avoid seeking treatment due to worries about cost.

While only 5% of people whose annual household income was over $100,000 would avoid seeking medical care if they had a dry cough or fever, this figure jumped to 22% for people whose annual household income was below $40,000.

Likewise, for those who suspected they had COVID-19 and had an annual household income of $100,000 or more, only 3% would avoid seeking treatment due to cost. The figure for those whose household income was under $40,000 was 14%.

According to Tim Lash, chief strategy officer for West Health, “[m]illions of Americans, even in the face of a disease that has brought a country to its knees, would forgo care due to the potential expense and still others may not be clear on the common symptoms of COVID-19.

“While physicians and healthcare workers are doing courageous and lifesaving work, the pandemic magnifies the longstanding perils and flaws of a high cost healthcare system in need of reform.”

While the poll makes clear that income affects the extent to which someone is likely to seek medical treatment, current U.S. government advice regarding COVID-19 may have affected the results of the poll.

According to the Centers for Disease Control and Prevention (CDC), if a person has a fever, dry cough, or other symptoms of COVID-19, then the official advice is to stay at home and self-care. Only if their symptoms get more severe should a person seek medical treatment.

The CDC have also clarified that all those with symptoms of COVID-19 are a priority for testing. They also express concern that if people are avoiding testing for fear of healthcare costs, it could affect the future monitoring of how the virus spreads when the government relaxes lockdown measures.

It may be that the respondents of the poll, knowing the official advice, would not seek treatment whatever their income.

Nonetheless, some people who responded to the poll were clearly concerned about costs. The results showed a clear correlation between these concerned people and relative annual household income.

The research also polled people on access to care, asking the respondents whether “[…] you or a family member been denied care by a hospital or a doctor due to heavy patient volume brought on by the coronavirus outbreak?”

Here, the researchers found that 6% of respondents had been denied access to care. However, again, the responses varied by annual household income: while only 3% of those whose annual household income was over $100,000 had been denied care, this figure rose to 11% for those whose annual household income was below $40,000.

According to Dan Witters, Gallup senior researcher, “[t]hese new findings align with previous research by West Health and Gallup on the impact of high healthcare costs in the U.S.

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