Regardless of income level, Californians across the board have been avoiding medical care during the COVID-19 pandemic, according to a new survey from the California Health Care Foundation and the University of Chicago. But for low-income residents and people of color, the consequences of delaying that care could be more dire.
Researchers polled 2,249 Californians of all income levels between age 18 and 64. About one-third of respondents said they had wanted care for an urgent health problem during the pandemic but didn’t receive it, and 45% said that was the case for a non-urgent health problem. When it came to mental health care, 44% of respondents said they wanted professional help but didn’t get it.
Carlina Hansen, senior program officer at California Health Care Foundation, says this is partly due to concerns around catching the virus in the medical setting. But their research also shows that barriers to health care such as challenges with child care or transportation have been exacerbated during the pandemic.
“Low-income individuals across the board experience a lot of stress … things like affording basic expenses, having children out of school,” Hansen said. “And most importantly concern about the health and wellbeing of loved ones.”
The survey found 96% of low-income Californians report struggling with the stresses of COVID-19, and 36% say their mental health has gotten “worse” or “a lot worse” since the start of the pandemic.
Gov. Gavin Newsom recently signed several bills that strive to address the growing mental health needs of Californians, including one that brings more peer support specialists into the behavioral health workforce, and one that requires insurance companies to cover more types of mental health care.
While those changes might improve access to care in the long-run, experts say there’s a more immediate solution in telehealth, or remote treatment. It allows the patient to talk to a health care provider via phone or video, and only go into a medical setting when it’s necessary for a test or procedure.
At the start of the pandemic, many clinics and doctors’ offices that were not offering telehealth had to quickly shift to virtual care. The California Health Care Foundation survey found that 62% of all respondents and 76% of respondents of color had a telehealth appointment during the pandemic.
About half of survey respondents said they were as satisfied with a remote appointment as they were with an in-person visit, and one-quarter said they were more satisfied.
Dr. Richard Florio, a vascular surgeon at Kaiser Permanente Roseville Medical Center, said he’s heard from patients that they like the convenience of being seen without leaving their own homes.
“Seeing them and meeting them where they’re at, you see this really rapid increase in patient comfort and acceptance of using video,” he said. “Once you cross that little threshold, you find that physicians and patients are very willing to try.”
Experts have noted that disparities in internet access may make it hard for some patients to use telehealth, and that health care providers should try to find ways to bridge that gap whenever possible.
There are also ongoing access issues for California’s undocumented immigrants, many of whom are ineligible for public health insurance options and may be afraid to seek any form of medical care due to fears about their status. Gov. Newsom had planned to expand Medi-Cal to undocumented seniors this year, but shelved the plan when the pandemic hit.
Some physicians are worried that if too many people avoid seeking medical care, be it a mental health issue or a preventive screening, there will be consequences down the line such as higher cancer rates in a few years.
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