Many insured Americans experience delays and denial of care because of health insurance

Washington, DC, October 28, 2024 – Many insured Americans struggle with access and affordability navigating the health care system, and support changes to address these issues, according to the latest Patient Experience Survey (PES). Only about one-quarter of insured Americans believe insurance currently provides everyone with affordable access to health care when it’s needed. Most insured Americans support policies that minimize out-of-pocket costs, like capping the out-of-pocket costs patients might pay in a year or ensuring that health insurers or pharmacy benefit managers (PBMs) pass on cost-savings to patients.

To learn more about previous waves of the PES, please follow the link here.

Explore some of the main findings here:

1. Access: Experience with delay and denial of care

2. Affordability: Out-of-pocket costs, medical debt, and deductibles

3. Americans’ health care priorities for policymakers

4. Innovation: Importance of choice, innovation, personalization, and prevention for Americans

1. Access: Experience with delay and denial of care

Even with insurance, many Americans struggle with health care access, with many saying insurance has delayed or denied them or a family member care.

• In the past year, two in five (41%) insured Americans taking prescription drugs report that they or a family member experienced barriers to health care because of insurance delaying or denying care. The challenge is even more common among Americans managing a chronic condition (51%).
• Right now, only about one-quarter of insured Americans believe insurance currently provides everyone with affordable access to health care when it’s needed.
• About two in five (43%) insured Americans are concerned their insurance company will deny future care.
• Moreover, roughly half of insured Americans can’t anticipate what they’ll pay for their prescriptions (51%) and have trouble understanding their health insurance coverage (45%).
• There is widespread support among all Americans and insured Americans (62% All Americans; 64% Insured Americans) who strongly agree on “cracking down on practices by PBMs and health plans like inappropriate fail first (step therapy) and prior authorization that can limit patient access to medicines.”

2. Affordability: Out-of-pocket costs, medical debt, and deductibles

Many Americans, including insured Americans, are just as worried about their ability to afford out-of-pocket health care costs as their ability to afford monthly groceries. Most insured Americans feel patients should have consistent out-of-pocket costs for their medication.

• In the next year, about half of Americans, including insured Americans, report concern with their ability to afford their out-of-pocket health care costs and their monthly groceries (52% of Americans overall are concerned about out-of-pocket costs and groceries vs. 52% and 51% of insured Americans are concerned about out-of-pocket cost and groceries, respectively).
• A third of insured Americans (33%) say their health care out-of-pocket costs for health care services have increased over the past year; the number is higher for prescription out-of-pocket costs (38%, among those taking prescription medicines).
• Additionally, about one in five (18%) report having outstanding medical debt, a figure that rises among people who report having most chronic conditions. Insured Americans with medical debt largely attribute it to hospital (59%), doctor (54%) and diagnostic testing (43%) bills.
• Affordability can also impact whether Americans take their medication as prescribed. A quarter (25%) of insured Americans taking prescription medicines report they did not take their medication in the last year because they could not afford it; among this group, the top reason reported was not being able to afford their copay.
• Among the tested policies to improve health insurance coverage, insured Americans’ prefer addressing out-of-pocket costs by reducing the burden of deductibles (34%) and having limits on out-of-pocket costs (34%). Predictability is also important for nearly all insured Americans; nine in 10 insured Americans (89%) agree that patients should have consistent out-of-pocket costs for medicines they need, with no surprises.

3. Americans’ health care priorities for policymakers

Ahead of the election, most Americans support policies lowering out-of-pocket costs, and feel that policymakers should understand the challenges they face in trying to get care.

• More than nine in 10 Americans (94%) say it is important for policymakers to understand the barriers and challenges patients face when accessing care.
• And while health care is not a top overall issue this election cycle, there are clear priorities: out-of-pocket costs stand out as the most important and concerning health care issue (32%).
• Reducing inefficiency and bureaucracy (80%) and reining in costs (78%), are also top issues that insured Americans specifically want candidates to address.
• Support is widespread on multiple policy solutions to address out-of-pocket costs, including setting a maximum limit for what patients pay out of pocket for their medicines each year (88%) and ensuring health insurers and PBMs pass on any rebates or discounts, so patients pay less out-of-pocket for their medicines (91%).

4. Innovation: Importance of choice, innovation, personalization, and prevention for Americans

Nearly all Americans want more choice and personalization in medicine and see the importance of preventative medicines.

• Most Americans (89%) prioritize knowing that their health care treatments and medicines are safe and effective.
• And most Americans (91%) say the availability of new and innovative medicines to treat and cure some of the deadliest, costliest and most frightening diseases gives them hope for the future.
• Similarly, an overwhelming majority (90%) of insured Americans agree that preventative medicines, such as vaccines, help patients avoid hospital stays, physician office visits and other, costlier health care services.
• Furthermore, large majorities want more choice in medicines to best personalize treatment to their needs (91%) and agree it is important to deliver medicines and treatments that are more personalized and convenient for patients who need them (95%).

To explore these findings more, please download the slides below.

About the Study

The Patient Experience Survey (PES) is a robust and reliable data source on patient perceptions and behaviors around access to health care and prescription medicines. A literature review was conducted around existing and relevant academic surveys, which helped to inform the questionnaire design. The questionnaire was tested and refined through a series of cognitive pre-tests and in-depth interviews to ensure measurement validity and reliability.

The survey was conducted July 19th – August 1st, 2024 by Ipsos using the probability-based KnowledgePanel®. The survey is based on a nationally representative probability sample of 2,592 adults aged 18 or older. The sample included 2,397 respondents who reported being insured, with in-depth findings across certain patient populations, demographics, geographic areas and disease states.

The survey was conducted using KnowledgePanel, the largest and most well-established online probability-based panel that is representative of the adult US population. The recruitment process employs a scientifically developed address-based sampling methodology using the latest Delivery Sequence File of the USPS – a database with full coverage of all delivery points in the US. Households invited to join the panel are randomly selected from all available households in the U.S. Persons in the sampled households are invited to join and participate in the panel. As a result of the recruitment and sampling methodologies, samples from KnowledgePanel cover all households regardless of their phone or internet status and findings can be reported with a margin of sampling error and projected to the general population.

The study was conducted in both English and Spanish. The data were weighted to adjust for gender by age, race/ethnicity, Census region by metropolitan status, education, household income, race/ethnicity by gender, race/ethnicity by age, race/ethnicity by education, and English language proficiency. The demographic benchmarks came from the 2023 March Supplement of the Current Population Survey (CPS) from the US Census Bureau, with the exception of the benchmarks for English language proficiency which were obtained from the 2022 American Community Survey (ACS) from the US Census Bureau. The weighting categories were as follows:

• Gender (Male, Female) by Age (18–29, 30–44, 45–59, and 60+)
• Race/Hispanic Ethnicity (White Non-Hispanic, Black Non-Hispanic, Other Non-Hispanic, Hispanic, 2+ Races Non-Hispanic)
• Census Region (Northeast, Midwest, South, West) by Metropolitan Status (Metro, Non-Metro)
• Education (Less than High School, High School, Some College, Bachelor or higher)
• Household Income (Under $25,000, $25,000-$49,999, $50,000-$74,999, $75,000-$99,999, $100,000-$149,999, $150,000+)
• Race/Hispanic Ethnicity (White and Other Non-Hispanic, Black Non-Hispanic, Hispanic) by Gender (Male, Female)
• Race/Hispanic (White and Other Non-Hispanic, Black Non-Hispanic, Hispanic) by Age (18–44, 45+)
• Race/Hispanic (White and Other Non-Hispanic, Black Non-Hispanic, Hispanic) by Education (Less than Bachelor, Bachelor or higher)
• Language Proficiency (English Proficient, Bilingual, Spanish Proficient, non-Hispanic)

The margin of sampling error is plus or minus 2.02 percentage points at the 95% confidence level, for results based on the entire sample of adults.

For more information on this news release, please contact:

Christopher Moessner
Senior Vice President, US
Public Affairs
+1 571-358-5411
[email protected]

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