“I Can’t Afford the Copays, So Guess I’ll Die?” Using Discounting Methodology to Quantify How Cost Affects Health-Care Utilization

The cost of health care in the United States is roughly twice as much as the average cost in comparable countries. Moreover, the United States also has the highest rate of deaths that could have been prevented by accessing health care. This is likely primarily a result of the privatized health system, which places the cost of care on the patient. Under this system, high costs create a barrier to utilization of health-care services. To better understand how health-care seeking changes as a function of cost, three experiments were conducted using crowd-sourced samples from Amazon Mechanical Turk (MTurk). These experiments were designed to assess the likelihood of seeking care based on cost, symptom, severity, and duration of symptom experienced. Effective durations of symptoms experienced when likelihood to see or contact a health-care professional was 50% (EDur50) was used to describe in days how cost delayed health-care seeking. A cost increase from $10 to $100 increased the EDur50 for a participant would see or contact a health-care professional by 1.4 to 2.5 times, whereas a cost increase from $10 to $1,000 increased EDur50 between 5.4 to 17.6 times. Physical health was consistently inversely related to EDur50 to see a health-care professional, whereas increased delay discounting of losses and decreased probability discounting of gains were related to decreased EDur50. This set of experiments adds to the body of evidence that substantial reforms are required in the American health-care system to ensure those who need health care can access it.