Reasons for Delayed Care Extend Beyond the Pandemic and Financial Concerns

By Beri Ridgeway, MD

As you are acutely aware, physicians have been on high alert for the last 12 months. We have tirelessly cared for our COVID-19 patients, non-COVID-19 medical patients and surgical patients. As the amount of COVID-19 in our communities trends down from its recent peak, the number of patients hospitalized with COVID-19 continues to decrease and with the vaccination efforts underway, we are beginning to look forward to creating our new normal.

As you may have noticed in your practice, fill rates are lower across the country than they have been in a while. At Cleveland Clinic, we’re seeing this decline in a number of ways, including:

• We have about 10-15% fewer ambulatory surgical patients.
• Across our Ohio locations, screening mammograms were down 16% in 2020 compared with 2019.
• Our own Cleveland Clinic survey found that just 52% of Americans reached out to a doctor or sought medical care after experiencing a concerning health issue.

I thought that I understood why. I thought that patients were delaying care because they were afraid of contracting COVID-19, or because it is hard to take care of our own needs during a pandemic. It turns out that that is only part of the story.

Delayed care not just from the pandemic

In a recent article published in JAMA Health Forum, the authors review the results of several nationally representative public opinion polls conducted during the pandemic to ascertain whether or not individuals with serious medical problems were able to access the medical care they needed during the COVID-19 pandemic.

First, the authors confirm our suspicions. Specifically, 31-42% of adults reported delaying medical care for non-COVID issues, including dental care, regular check-ups, treatment for ongoing conditions, diagnostic or medical screening tests, vision care and surgical procedures. In addition, 1 in 5 adults in the U.S. reported their household members were unable to get – or delayed getting – medical care for serious problems. Among those reporting delayed care, about 57% said they experienced negative health consequences as a result.

The authors also address the reasons patients gave for why their care was delayed. I always assumed it was due to fear or a preoccupation with the pandemic. Interestingly, among the general U.S. population reporting delayed care for serious problems, 69% cited financial and access barriers unrelated to COVID-19. This included reasons like being unable to get an appointment, find a physician who would see them, or being unable to access the care location. Importantly, the authors note that there weren’t significant differences in delayed care for serious medical problems based on insurance status, type or racial/ethnic group.

While the issue of access was exacerbated by the COVID-19 pandemic, it’s nothing new to healthcare. Think of the last time you personally made an appointment for yourself or a family member using traditional means. I bet many physicians circumvent the system to get care, meaning we may be unaware of the challenges our patients face just trying to make an appointment. Sometimes purchasing something online or making cross-country flight arrangements is easier than accessing medical care.

Short-term fixes and long-term transformation

In healthcare, we must find ways to remove these barriers and make it easy for patients to access the care they need. As an organization, Cleveland Clinic has begun to systematically look at how we connect patient with care, and we are approaching this with a leave-no-stone-unturned strategy. We are creating short-term fixes and long-term transformation.

Physicians throughout the U.S. need to take a closer look at their own practices, and think of what they can do to improve access. It may include removing private appointment slots, making appointment types less specific and, most importantly, reaching out to patients who you know have deferred care.

Many doctors have deferred their own care

As doctors who have survived 2020, most of us have deferred care for ourselves, including deferring health screenings or ignoring our own health conditions. Now is the time for you to take inventory of your own health, and schedule the appointments you need to take care of yourself. Prioritizing your own health will ensure that you can provide quality care as we move beyond the COVID-19 pandemic.

About the author:Beri Ridgeway, MD (@beridgeway), who subspecialized in urogynecology, became Chief of Staff at Cleveland Clinic in January 2021. Dr. Ridgeway joined Cleveland Clinic in 2009 as a staff physician in the Department of Obstetrics and Gynecology. She led the Women’s Health Institute for more than two years, and was named Associate Chief of Staff in 2019.