The COVID-19 pandemic was the most common reason that high-need New Yorkers delayed or forwent care in 2021, with more than half of economically disadvantaged New Yorkers (54%) and more than two- thirds of more-advantaged New Yorkers (69%) citing it. Notably, the pandemic became less of an obstacle over time: in 2022, only 19% of economically disadvantaged New Yorkers and 36% of more-advantaged New Yorkers who delayed or forwent care did so due to the pandemic. For economically disadvantaged New Yorkers, affordability of care was a significant obstacle to receiving care in both 2021 and 2022. High cost of care became the most common reason that economically disad- vantaged New Yorkers delayed or forwent care in 2022 (42%), despite a decrease relative to 2021 (49%), and they were three times more likely than more-advantaged New Yorkers (13%) to cite this reason. Lack of insurance coverage was also a notable barrier to healthcare access for economically disadvantaged New Yorkers: one in five (20%) delayed or went without healthcare in 2022 because of a lack of insurance, a sev- en-percentage-point increase from earlier in the pandemic (13%). By contrast, a lack of insurance hindered just 1% of more-advantaged New Yorkers from receiving care in 2022. 10 In 2022, economically disadvantaged New Yorkers also struggled with the availability of healthcare. They increasingly delayed or forwent care because they did not have a regular doctor (from 12% in 2021 to 17% in 2022), while more-advantaged New Yorkers experienced a decrease in this issue, from 16% to 4%. Further, about a quarter (24%) of economically disadvantaged New Yorkers who delayed or went without healthcare in 2021 did so because they did not know where to go to receive care, a reason that persisted in 2022 (23%). In comparison, 20% of more-advantaged New Yorkers delayed or forwent care because they did not know where to go in 2022, down from 24% in 2021. While the pandemic itself played a substantial role in keeping high-need New Yorkers from receiving the care that they needed, other factors continued to make it difficult for high-need New Yorkers to receive healthcare. Issues of affordability, as well as the availability of care, limited healthcare use among high-need New Yorkers, especially among those facing economic disadvantage. Below, we continue to explore how affordability continues to be a barrier to healthcare access among high-need New Yorkers. Healthcare affordability and economic barriers to care Affordability is a core determinant of the ability to receive healthcare. As seen above, the cost of receiving healthcare can prevent those with high need from getting the care they need, especially those already fac- ing economic disadvantage. We now zoom in on economic barriers to healthcare receipt among high-need New Yorkers over the course of the pandemic, focusing on prescription drug access and health insurance coverage. Earlier, we found that one reason high-need New Yorkers delayed healthcare was because the cost to see a physician was too high. However, patients often bear other costs too: prescriptions and needed medical de- vices may be expensive, even among patients with health insurance. During the pandemic, high-need New Yorkers facing economic disadvantage were more likely to skip, take less of, or delay filling a prescription than their more-advantaged counterparts (Figure 5). While skipping or delaying a prescription became less common among more-advantaged New Yorkers as the pandemic started to wane (6% in 2022, compared to
10 Tipirneni et al., “Association between health insurance literacy and avoidance of health care services owing to cost.”
PATTERNS OF DELAYED HEALTHCARE AMONG NEW YORKERS WITH HIGH HEALTHCARE NEED 11
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