Reasons for delaying or forgoing healthcare among high-need New Yorkers Delaying or forgoing necessary healthcare can lead to worsening symptoms and exacerbate the underlying illness, thus potentially increasing the future need for care. 8 The decision to delay or forgo care, however, can be driven by a variety of factors. Angela, a New Yorker we interviewed at length about her experiences with the healthcare system, describes the complex ways these factors play out in people’s real lives. Pursuing healthcare under economic duress: Angela’s story Angela has been in the shelter system since losing her apartment shortly before the pandemic be- gan. She contends with chronic health conditions, including arthritis and hypertension, and is a single parent of three children, all of whom have developmental delays. Her story illustrates how balancing a family’s high healthcare needs with the pressures of economic disadvantage and unstable living conditions can lead one to delay or even forgo needed physical and mental healthcare. Navigating doctor’s appointments for her children in the city hospitals where they receive care became increasingly challenging for Angela since the restrictions were put in place at the height of COVID: “It took me three months to get them [annual] physicals because you can’t bring all the kids together anymore.” Meanwhile, getting her own appointments with any provider besides a general practitioner became more difficult: “This [rheumatology] appointment only comes around once a month, and can only be done at one time in the morning. They don’t even have later appointments, nothing past noon. Any kind of specialty thing, which was hard before COVID, is impossible now.” Given this restricted avail- ability, Angela sometimes lost crucial income in favor of a doctor’s appointment: “ Your next appoint- ment will be next month, so you can’t miss that appointment. I actually missed a job on the fourth because I [had] to go [for an] MRI… I wanted that money, but my health is more important. ” Angela knew the stakes of missing an appointment that could not be easily rebooked: “ For the ophthalmolo- gy appointment, I waited a whole year. They gave me the appointment two months afterwards—two months after I requested it, but it was like for next year. I was like, ‘What? Does that really say 2023? ’” When insurance does not cover certain care, many postpone it indefinitely; for Angela, this was the case with much-needed mental healthcare. Given the stressors of being a single parent of high-need children, managing remote schooling during the pandemic and continually searching for an afford- able apartment, Angela feels she could benefit from a counselor’s support. However, she has had difficulty finding mental health services that are the right fit and covered by insurance. She sought care through a CNYC website that claimed to offer free counseling, but, she says: “ I couldn’t get past their automated thing, and the automated thing was like, ‘Do you wanna kill yourself? Do you wanna kill yourself? Do you wanna kill yourself?’ Like, ‘No!’ It’s like it became painfully aware to me that it was for people who were in crisis. It’s like, ‘I’m not in crisis, but I don’t wanna get there.’” Angela knows that seeking mental healthcare through her primary care doctor can “take forever,” as it requires securing a referral and then waiting for a mental health provider to have availability, let alone knowing if that person will be the right fit. And a good fit in a therapist was key for Angela, who notes, “A therapist actually has to have a relationship with you.” She expects that she will need to seek this care outside of what is covered by her insurance: “I just get the feeling that [therapy is] something I’m gonna have to pay for… but I just can’t afford it right now.” At the follow up interview a year and a half later, she still has not received this care.
8 Weissman et al., “Delayed access to health care: Risk factors, reasons, and consequences.”
PATTERNS OF DELAYED HEALTHCARE AMONG NEW YORKERS WITH HIGH HEALTHCARE NEED 9
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