Older Adults’ Perspectives on Emergency Department Costs during COVID-19

Objectives: COVID-19 has strained the household finances of many Americans already experiencing increasing healthcare expenses. Concerns about the cost of care may deter patients from seeking even urgent care from the emergency department (ED). This study examines predictors of older Americans’ concerns of ED visit costs, and how cost concerns may have influenced their ED use in the early stages of the pandemic. Study Design: This was a cross-sectional survey study using a nationally representative sample of US adults aged 50-80 years (N=2,074) in June 2020. Methods: Multivariate logistic regressions assessed the relationship between sociodemographic, insurance, and health factors with cost concerns for emergency department care. Results: Of the respondents, 80% were concerned (45% very, 35% somewhat) about costs of an ED visit and 18% were not confident in their ability to afford an ED visit. Of the entire sample, 7% had avoided ED care due to cost concerns in the past two years. Of those who may have needed ED care, 22% had avoided care. Predictors of cost-related ED avoidance included: aged 50 to 54 years (4.57 aOR [95%CI 1.44-14.54]), uninsured (2.93 aOR [95%CI 1.35-6.52]), poor-fair mental health (2.82 aOR [95%CI 1.62-4.89]), and income <$30K (2.30 aOR [95%CI 1.19-4.46]). Conclusions: During the early COVID-19 pandemic, most older US adults expressed concerns about the financial impact of ED use. Further research should examine how insurance design could alleviate the perceived financial burden of ED use and prevent cost-related care avoidance, especially for those at higher risk in future pandemic surges.