Reports of Forgone Medical Care Among US Adults During the Initial Phase of the COVID-19 Pandemic | Health Disparities | JAMA Network Open | JAMA Network
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    Original Investigation
    Health Policy
    January 21, 2021

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

    Author Affiliations
    • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    JAMA Netw Open. 2021;4(1):e2034882. doi:10.1001/jamanetworkopen.2020.34882
    Key Points

    Question  What are the frequency of and reasons for reported forgone medical care from March to mid-July 2020, the initial phase of the coronavirus disease 2019 (COVID-19) pandemic in the US?

    Findings  In this national survey of 1337 participants, 41% of respondents reported forgoing medical care from March through mid-July 2020. Among adults who reported needing care during this period, more than half reported forgoing care for any reason, more than one-quarter reported forgoing care owing to fear of severe acute respiratory syndrome coronavirus 2 transmission, and 7% reported forgoing care owing to financial concerns.

    Meaning  This survey study found that there was a high frequency of forgone care from March to mid-July 2020, with respondents commonly attributing the causes of forgone care to repercussions 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.

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