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• Posted January 30, 2024

Cost, Job Worries Have Many Americans Postponing Surgeries

Older adults frequently delay needed surgery because of financial concerns, a new study finds.

Nearly half of people ages 50 and older who were very concerned about the cost of surgery wound up not having an operation they had considered, researchers reported Jan. 30 in the journal JAMA Network Open.

Further, more than half who were very concerned about taking time off work wound up dropping plans for surgery, results show.

“When I counsel patients in my clinic who are considering elective surgery, I now also spend a good deal of time discussing the financial and employment implications of surgery with them,” said researcher Dr. Nicholas Berlin, a surgical fellow with the University of Michigan Medical School.

“Unfortunately, I have seen a number of insured patients forego needed surgery because they are unable to afford the out-of-pocket costs or take time away from work for recovery,” Berlin added in a university news release.

For the study, Berlin and his colleagues analyzed data from the National Poll on Healthy Aging, which showed in 2022 that nearly half of older adults considering surgery had concerns about costs, work time lost or COVID risk.

About two-thirds who said they were very concerned about COVID exposure during surgery or recovery wound up not having an operation they had considered, researchers found.

On the other hand, few patients dropped plans for surgery due to concerns over pain or recovery.

For instance, those very concerned about surgery-related pain were as likely as those with no concerns about pain to proceed with their planned operation, results show.

Berlin said that federal policymakers have tried to address cost issues by requiring price transparency from hospitals. Those efforts also include reducing the amount of tacked-on “surprise” billing that can occur when someone receives care from a provider not in their insurance network.

However, those policies don't address lost wages from taking work off for surgery or costs related to the way a person's health insurance is structured, Berlin said.

For example, over the past two decades the percentage of people over 60 who work has doubled. At the same time, enrollment in limited-network Medicare Advantage plans and high-deductible heath plans has grown.

More research is needed to understand what influences a person's decision to proceed with operations, said poll director Dr. Jeffrey Kullgren, an associate professor of internal medicine at the University of Michigan.

“More research is needed to understand and address caregiver impacts, which were also a factor in not having surgery for some people in the study,” Kullgren added. “This includes both those who are concerned about surgery temporarily making them unable to care for someone else, and those concerned about having someone to care for them after their operation.”

The poll included 2,110 adults between the ages of 50 and 80, of whom 32% had considered an elective surgical procedure in the previous five years. Two-thirds of those who considered an operation wound up going through with it.

The most common elective operations were knee or hip replacement, cataract surgery, hernia repair, gall bladder removal and hysterectomy, results show.

Those procedures can be medically necessary and covered by insurance, but some participants also had considered cosmetic surgery, which is paid for entirely out of pocket.

More information

Harvard Medical School has more about hospital price transparency.

SOURCE: University of Michigan, news release, Jan. 30, 2024