Trends in Self-reported Forgone Medical Care Among Medicare Beneficiaries During the COVID-19 Pandemic

Abstract

Importance: Evidence suggests that the COVID-19 pandemic has had a negative association with medical care access. As prior studies mainly focused on the initial stage of the COVID-19 pandemic, less is known about how trends in forgone medical care changed over time.

Objective: To examine trends in and reasons for forgone medical care among Medicare beneficiaries during the COVID-19 pandemic.

Design setting and participants: This cross-sectional study analyzed Medicare beneficiaries using data from 3 waves of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement (Summer 2020, Fall 2020, and Winter 2021). Data analyses were conducted between July and August 2021.

Exposures: Date of interview.

Main outcomes and measures: Self-reported forgone medical care because of COVID-19.

Results: A total of 23 058 Medicare beneficiaries were included (13 005 women [56.4%]; 10 445 [45.3%] 75 years old and older). The survey response rates for each wave were 72.6%, 78.95, and 79.6%, respectively. The rates of reported forgone medical care because of COVID-19 decreased from the week of June 7, 2020, to the week of April 4 to 25, 2021, but the largest difference in the rates was found between June 7 and July 12, 2020 (22.4% to 15.9%). Physician-driven factors accounted for about 70% of the forgone medical care. The proportion of those who reported forgoing medical care because of physician-driven factors tended to decrease from 66.2% in the week of July 7, 2020, to 44.7% in the weeks of April 4 to 25, 2021. The likelihood of forgone medical care was 4 percentage points (95% CI, 0.03-0.05) higher among those who reported feeling more stressed or anxious than those who did not, 3 percentage points (95% CI, 0.01-0.04) higher among those who reported feeling more lonely or sad than those who did not, and 3 percentage points (95% CI, 0.01-0.04) higher among those who reported feeling less socially connected than those who did not.

Conclusions and relevance: The results of this cross-sectional survey study suggest that the COVID-19 pandemic may exacerbate existing barriers to care and lead Medicare beneficiaries to delay needed care. Policy makers must continue to identify effective means of meeting the forgone care backlog and maintaining continuity of care, especially for those with mental health problems.

Figure 1.. Adjusted Rates of Forgone Medical Care Because of COVID-19 Reported Among Medicare Beneficiaries by Date of Interview

Adjusted rates were estimated using a linear probability model on forgone medical care while controlling for age, sex, race and ethnicity, income, rural residence, census region of residence, Medicaid eligibility, use of a language at home other than English, access to telemedicine, ability to access basic needs during the COVID-19 pandemic, self-reported health conditions, and the date of interview. Then, we estimated the adjusted rates of the outcome by date of interview. For all analyses, we accounted for complex sample design with sampling weights provided by the Medicare Current Beneficiary Survey (MCBS) to generate nationally representative estimates.

Figure 2.. Reasons Reported for Forgoing Planned Care Because of COVID-19 Among Medicare Beneficiaries by Date of Interview

Participants were allowed to report multiple reasons for forgone medical care because of COVID-19.

Figure 3.. Adjusted Rates of Reported Forgone Medical Care Because of COVID-19 Among Medicare Beneficiaries by Date of Interview and Mental Health Status

Adjusted rates were estimated using a linear probability model on forgone medical care while controlling for age, sex, race and ethnicity, income, rural residence, census region of residence, Medicaid eligibility, use of a language at home other than English, access to telemedicine, ability to access basic needs during the pandemic, self-reported health conditions, the date of interview, mental health status, and interaction term between the date of interview and mental health status. Then, we estimated the adjusted rates of the outcome by date of interview and mental health status. For all analyses, we accounted for complex sample design with sampling weights provided by the Medicare Current Beneficiary Survey (MCBS) to generate nationally representative estimates.