One of the worst symptoms of struggling financially may be the impact it has on health care decisions—or lack thereof.
Low-income individuals don’t always tell their doctors the truth about their financial hardships, or that they’re choosing to pay for their food and rent over medications and other health care, according to a recent report from University of Texas’s Southwestern Center for Patient-Centered Outcomes Research.
As a result, their doctors think they’re simply failing to follow instructions. “This financial strain can cause non-adherence to physician recommendations that appear to reflect a patient’s lack of engagement in care,” said Oanh Nguyen, lead author of the report. “However, this ‘nonadherence’ is actually the result of rational and difficult trade-offs to cope with financial strain.”
The researchers conducted 12 focus groups with people primarily in their 40s and 50s at Crossroads Community Services, a Dallas-based nonprofit organization that offers food assistance and other support to low-income families. Their next steps will be to find ways physicians can recognize the financial strains their patients are facing, and make medical recommendations accordingly.
See: 5 ways to lower health care costs in the U.S.
One in four Americans has refused medical care because of the cost, a 2017 study from Bankrate.com found. A third of older millennials (aged between 27 and 36) were more likely to turn down care because they couldn’t afford it. Health insurance plays a role in this: More than half of Americans are worried they won’t be able to afford health insurance in the future. Generation Xers, people between 37 and 52, were most concerned (64%), followed by baby boomers (58%).
Solutions to this problem include doctors and patients having more open discussions about the cost of medicines, and finding one that the patient can afford. There may be some medications patients can skip altogether, Nguyen added. And that responsibility lies with the doctor as well as the patient.
Doctors don’t always know what to say about financial struggles or medical care affordability, another report published in the journal Health Affairs in 2016. found. Researchers from Duke University reviewed transcripts of 2,000 physician-patient conversations, in which case some patients brought up affordability, and found doctors dismissed those concerns, by either not acknowledging them completely or not addressing them completely.
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People tend to wait for some financial windfall before they visit the doctor. Health care was the top expenditure for the first 100 days after people received tax refund payments, according to a recent J.P. Morgan Chase Institute report, especially among cash-strapped families. Out-of-pocket medical expenses on debit cards increased 83% after a tax refund check arrived, with no real change to credit-card spending.