Older Americans skipping surgeries over cost, missed work worries

Older Americans may forego elective surgeries because they are worried about out-of-pocket expenses and time away from work, along with potential exposure to COVID-19.

This is according to a study by the University of Michigan Institute for Healthcare Policy and Innovation, which discovered that these factors tend to dissuade older Americans from going through with surgeries more than concerns about pain or the recovery process.

Nearly half of those who said they were very concerned about cost and more than half of those who were very concerned about taking time off of work ended up not having a surgery they were considering, the study found. However, those who were concerned about surgery-related pain were just as likely as those with no concerns about pain to go ahead with surgery.

In the past two decades, the percentage of people over 60 who work has doubled, and enrollment in Medicare Advantage plans with limited networks, and in high deductible health plans, has grown, the report noted. The most common elective operations considered by poll respondents were hip or knee replacement, cataract surgery, hernia repair, gallbladder removal and hysterectomy, all of which can be medically necessary and covered by insurance. 

“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 the survey with them,” said surgeon Nicholas Berlin M.D., an author of the report. “Unfortunately, I have seen a number of insured patients forgo needed surgery because they are unable to afford the out-of-pocket costs or take time away from work for recovery.”

Policymakers have tried to address this issue by requiring hospitals to make prices for operations more transparent, but these policies don’t address financial concerns about losing wages from employment that doesn’t come with paid time off, or costs related to the way a person’s health insurance is structured. 

Related: How health insurance has become a barrier to health care 

The study speculates that the COVID-19 concerns were likely a reflection of the timing of the original poll, which was conducted in August 2021 and covered a period of five years prior. At the time, two-thirds of those who said they were very concerned about COVID-19 exposure in the surgery and recovery process ended up not having an operation they had considered.

Poll director and senior author of the new paper Jeffrey Kullgren, M.D., a primary care physician, said caregiving concerns also play a role in decisions about whether to go ahead with surgery – both in terms of patients concerned they won’t be able to care for someone else who relies on them and those worried about needing somebody to take care of them during recovery.