Evaluating Trends and Disparities: Financial Barriers to Care Before, During, and After COVID-19

Music City Center 

Introduction: Recent pre-post studies suggest improved healthcare affordability during the COVID-19 pandemic. However, these studies do not account for temporal trends or racial disparities. In this study, we use interrupted time series (ITS) and difference-ITS (d-ITS) analysis to examine trends in financial hardship.
Methods: We analyzed 2017-2023 NHIS data on U.S. adults, considering financial hardship from and inability to pay medical bills, and delayed and foregone care due to cost. Crude and adjusted ITS and d-ITS models were developed for each outcome, with 2020 as the interruption point.
Results: Black adults have an overall higher risk for all outcomes (p<0.001). The overall odds of foregone care (OR: 1.09) and inability to pay bills (OR: 1.27) were on the rise leading up to COVID-19.  The immediate effect of COVID was a 21% decrease in the odds of delayed care but 86% increased odds in inability to pay. Since 2020, the odds of foregone care and inability to pay have declined by 8% and 20% annually, with no significant differences in trends by race.
Conclusions: Despite overall disparities, barriers declined post-COVID potentially due to pandemic-era safety net policies.

COVID-19

Delayed Care

Disparities

Financial Hardship

Interrupted Time Series

Health Policy 

Health Policy Statistics Section