More than 1 in 3 working-age Americans skipped a doctors’ visit or medical test, or didn’t fill a prescription, because of the cost last year, according to a recent survey by the Commonwealth Fund, a nonprofit health-research foundation.

Myer, who has insurance, has been forgoing weekly injections for low testosterone, getting them only once a month or less. “That prescription is also just sky-high,” he said, costing about $75 per visit until he reaches his health plan’s deductible.

The medical costs add to a pile of student loans, credit-card debt and payments on his Nissan Rogue. He recently moved back in with his father after he couldn’t afford a rent increase. He also owes money to a psychiatrist who charges a sliding-scale fee. Getting a new prescription for his vision is Myer’s priority, though.

Spring Surge

Dentists and physicians’ offices accounted for the greatest share of in-person health payments that followed tax refunds, the JPMorgan Chase Institute’s report showed. Mark Vitale, a dentist in Edison, New Jersey, said refunds always bring a surge of patients.

“Year after year, what patients will say to me is, ‘Let’s just wait until April 1 or May 1 when I get my tax refund,’” he said. Vitale has practiced for 35 years, and over time, he said, “the dollar has gotten tighter.’’

Three people who booked significant dental procedures like implants or crowns around the beginning of April cited their tax refunds, he said. They’re typically employed, middle-class people. Sometimes they’ve delayed dental work for years.

The research group analyzed data from millions of Chase bank accounts, as well as credit and debit cards, looking for patterns in the movements of money.

The granular picture of how cash flow affects people’s ability to get medical care reveals problems that clinicians, health plans, employers and financial companies ought to grapple with, said Greig.

Doctors need to talk to patients about how to prioritize care if they can’t pay for it. That conversation now happens “in a very incomplete way” with finance staff, rather than clinicians, she said. Employers and health plans should understand that trying to lower spending by pushing more expenses onto households could backfire if they delay care.