Maine Data Glimpse: Delayed Medical Care

Analysis from Jessica Carson, Ph.D. and Sarah Boege at Carsey School of Public Policy at the University of New Hampshire and commissioned by the John T. Gorman Foundation.

This Data Glimpse describes data on delayed health care visits among adults and children during the pandemic from the U.S. Census Bureau Household Pulse Survey collected from mid-August 2020 through May 2021.

One-in-Five Maine Adults Delayed Medical Care Because of the Pandemic

In Maine, 22.8 percent of adults reported delaying non-coronavirus-related medical care in the last four weeks because of the pandemic (from data collected August 19, 2020 – May 24, 2021), no different from shares in Northern New England, New England, and the U.S. (all 22 to 23 percent). Delaying care was more prevalent among working-age Mainers compared to older adults (24.1 versus 19.5 percent; Figure 1), and more prevalent among Maine women than among Maine men (24.5 percent and 21 percent, respectively).

Assessments by race and ethnicity are not possible for Maine alone due to insufficient sample sizes, however, estimates are available for New England (Figure 2). Adults identifying as “any other race” or multiracial were most likely to report delaying medical care (26.2 percent). Black adults were least likely to have delayed care, although notably the share of respondents who did not answer was highest among Black and Hispanic/Latinx New Englanders (both around 30 percent). All other groups hovered around the New England-wide average (from 22.4-23.7 percent).

One-in-Six Report Missing Medical Care Entirely

Adults were also asked about missing care altogether, and although lower than the share of Maine adults who delayed care, nearly one-in-six Maine adults (16 percent) reported that they did not get medical care they needed because of the pandemic. The share not getting care was similar among adults in Northern New England, New England, and nationwide at 15 to 17 percent. As with delaying care, Maine women and working age adults (ages 18-64) were especially likely to report missed care (see Figure 3).

There were also differences in adults missing medical care by race-ethnicity in New England (Figure 4). Adults identifying as “any other race” or multiracial were most likely to have reported that they were not able to get needed care due to the pandemic (at 21.1 percent), followed by adults identifying as Hispanic/Latinx (at 17.9 percent).

Maine Kids Missed or Delayed Care Too

Beginning in mid-April 2021 (Phase 3.1 of the Household Pulse Survey), a question was added regarding whether any children in the household had missed or delayed any preventive check-ups over the past 12 months due to the COVID-19 pandemic (Figure 5, data collected from April 14 – May 24, 2021). Only adults who reported living in a household with at least one child were asked this question and responded on behalf of children in the household.
An estimated 23.5 percent of Maine households with children had at least one child miss or delay a preventive health care visit in the last year due to the pandemic. This share was similar to levels in Northern New England, and slightly higher than in New England or the U.S. (18.0 and 18.3 percent, respectively).

Among the New England states, Vermont and Maine had the highest shares of households with children that reported at least one child missing or delayed a preventive check-up in the last year (Figure 6).

While adults were not asked for the reason for their health care disruption, the new series of questions regarding children’s preventive health care does ask why care was missed or delayed. Those who indicated that a child in their household had missed or delayed preventive care in the last 12 months were then given a list of possible reasons and could select all that applied (see Table 1).

The two most common reasons selected were that a health care provider was open but had limited appointments or that there was concern about going to the provider’s location due to the pandemic. Also commonly selected was the reason that the health care provider’s location was closed due to the pandemic. The least commonly selected answer was that the child had changes to their health insurance or no longer had health insurance due to the pandemic.

Conclusion

During the pandemic, many families have had to delay or forgo non-coronavirus-related medical care. One-in-five Maine adults delayed, and one-in-six didn’t receive, needed care due to the pandemic. There is substantial (but not complete) overlap in Mainers who report delaying care and those who report missing it altogether: 9.1 percent of adults reported only delaying care, 2.3 percent reported only missing it, and 13.7 percent reported both, meaning that a full one-quarter of Maine adults had at least some prior-month disruption to health care access in the pandemic.

This needed care could range from routine or preventive care to more acute or emergency care needs. Delaying care, or not getting it at all, could lead to worse health outcomes for these adults through missing important screenings, not properly managing chronic illnesses, or worsening conditions.1 In Maine, women and working-age adults were more likely to have delayed or missed care than their peers, perhaps in part because of inflexible employment or child care situations. Researchers estimate that pandemic-related delays in breast and colorectal cancer screenings and treatment alone could lead to nearly 10,000 excess deaths over the next decade in the United States.2 Amid these healthcare disruptions, analysis of state data from the Maine Center for Economic Policy finds that an additional 25,000 Mainers enrolled in the expanded Medicaid program between March 2020 and January 2021, reflecting the economic impact of the pandemic.3 Without this safety net, health care disruptions might have been even greater. It is important that health care providers anticipate and prepare for the impacts of delayed care and changes to individuals’ health insurance coverage post-pandemic as they encourage patients to begin scheduling visits again.

Many children have also missed out on crucial preventive health care visits during the pandemic. A 2014 CDC report notes that even pre-pandemic, many children were not receiving all recommended clinical preventive health care.4 During the pandemic, more than one-in-five Maine households with children had at least one child who missed or delayed a preventive check-up in the last year due to the pandemic. The most common challenges were getting limited medical appointments and concern about going to a medical provider’s office location during the pandemic. Health care providers can follow up with families that have missed check-ups during the pandemic and make sure they are aware of increasing appointment availability and safety of visiting providers’ locations. For those still wary of in-person visits, telehealth options may present an opportunity to continue engaging in routine check-ups.

About the Data

The U.S. Census Bureau created the Household Pulse Survey (HPS) as an experimental data product to collect timely data on household experiences during the pandemic. Phase 1 of the HPS began April 23, 2020, and continued weekly through July 21, for a total of 12 weeks. Phase 2 ran from August 19 to October 26 and is followed by a Phase 3 from October 28 to March 29, 2021. Phase 3.1 recently begun on April 14, 2021. Rather than being weekly, each Phase 2, Phase 3, and Phase 3.1 release now covers two weeks of data collection, although each release is still referred to as a numbered “week” to remain consistent with Phase 1. For example, the available “weeks” of Phases 3.1 focused on in this this data glimpse are Week 28 – Week 30 (covering April 14 – May 24, 2021). Importantly, questions regarding children missing or delaying preventive check-ups were added to the Phase 3.1 questionnaire and in the field beginning April 14, 2021.

The question regarding gender allows the respondent to select only one of two possible answers, “male” or “female.” The racial categories available in the Public Use Files (PUF) are limited to “white, alone” “Black, alone” “Asian, alone” and “Any other race alone, or race in combination.” The question regarding ethnicity asks, “Are you of Hispanic, Latino, or Spanish origin?” with possible responses “yes’ or “no.” Questions where adults were asked about their own health care delays were analyzed using person weights and replicate weights; questions where adults were asked about missed or delayed health care among any children in their household were analyzed using household weights and replicate weights.

 

Footnotes:

1 See https://calmatters.org/health/2021/04/doctor-visits-deaths-diseases/ and https://jamanetwork.com/journals/jama-health-forum/fullarticle/2774358
2 https://science.sciencemag.org/content/368/6497/1290
3 https://mainebeacon.com/medicaid-expansion-a-lifesaver-for-thousands-of-mainers-grappling-with-covid-impacts/
4 https://www.cdc.gov/media/releases/2014/p0910-preventive-care.html