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While financial hardship can serve as an obstacle to medical care, long wait-times for appointments and inability to take time off work are more common barriers to healthcare access, a new study found.

While nearly 19% of Americans reported costs as a factor in preventing them from seeking necessary healthcare, 21% of U.S. adults surveyed said they have delayed care for non-financial reasons, according to a study published online in the journal Health Services Research.

"In the minds of many people, they often equate affordability with access, when in reality there are all kinds of reasons why people can't get the care that they need when they need it," said lead author Jeffrey Kullgren, MD, from the Philadelphia VA Medical Center, in a press release.

Kullgren and colleagues used data from the 2007 Health Tracking Household Survey to assess delays to care. This telephone survey collected information from nearly 18,000 people across the U.S. in 2007 and 2008.

The survey was conducted by the Center for Studying Health System Change, was administered in both English and Spanish, and had a response rate of 47%.

About 15,000 adults responded to the questions: "During the past 12 months, was there any time when you didn't get the medical care you needed?" and "Was there any time during the past 12 months when you put off or postponed getting medical care you thought you needed?"

Of those 15,000, nearly 19% answered that they did not get needed medical care or delayed medical care because they were worried about the cost or their health insurance would not pay for treatment.

One in five of the surveyed adults said they experienced non-financial barriers to receiving care that included being too busy with work or other commitments; not being able to get to the doctor's office during normal business hours; not being able to get an appointment soon enough; and a long commute to the doctor's office.

Two-thirds of the people who reported having trouble paying for medical care also reported experiencing non-financial barriers to care.

The study also found that:

• People younger than 55 had more non-financial barriers to care than older people (P=0.001), including issues with getting to appointments and not being able to seek treatment during normal business hours
• Women had higher prevalences of accommodation barriers than men, meaning the operating hours or appointment system was a barrier to care (17.4% versus 14.5%, P=0.001)
• African Americans had higher prevalence of accessibility barriers than white (4.8%versus 2.9%, P=0.02)
• Adults in households with annual incomes below $50,000 were more likely than the high-income individuals to have both affordability issues (19.3% versus 10%; P<0.001) and non-financial barriers (21.2% versus 16.5%, P =0.001)
• Part-time workers were more likely than full-time workers to say accommodation barriers prevented them from seeking care (18.2% versus 14.2%, P=0.002)
• Parents were more likely than adults without children to report accommodation barriers (18.3% versus 14.6%, P=0.001)

The authors questioned whether the healthcare reform law, which contains provisions designed to make care more affordable, will actually make it easier to seek medical treatment without addressing non-financial reasons that people skip or delay medical care.

As the Affordable Care Act is implemented, thought needs to be put in ways to improve access to care, the authors said. For instance, offering night and weekend outpatient services; increasing the use of telemedicine so patients don't always need to travel to see a doctor in-person; and offering onsite care for people with inflexible work schedules.

"These non-financial barriers present important opportunities for both policymakers and researchers to ensure that investments aiming to improve the affordability of health services for U.S. adults translate into actual advances in access to care," the authors concluded.

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