Reduced Access to Care

Household Pulse Survey

census experimental data

To rapidly monitor recent changes in mental health, the National Center for Health Statistics (NCHS) partnered with the Census Bureau on an experimental data system called the Household Pulse Survey. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S. The data collection period for Phase 1 of the Household Pulse Survey occurred between April 23, 2020 and July 21, 2020. Phase 2 data collection occurred between August 19, 2020 and October 26, 2020. Phase 3 data collection occurred between October 28, 2020 and March 29, 2021.Phase 3.1 data collection occurred between April 14, 2021 and July 5, 2021.

In Phases 1, 2, 3, and 3.1, NCHS included questions about the impact of the coronavirus pandemic on unmet needs for care. These questions were removed for Phase 3.2 data collection. Unmet needs for health care are often the result of cost-related barriers. The National Health Interview Survey (NHIS), conducted by NCHS, is the source for high-quality data to monitor cost-related health care access problems in the U.S. For example, in 2019, 8.3% of adults aged 18 and over did not get needed medical care due to cost in the past 12 months. However, cost is not the only reason someone might delay or not receive needed medical care. As a result of the coronavirus pandemic, people also may not get needed medical care due to cancelled appointments, cutbacks in transportation options, fear of going to the emergency room, or an altruistic desire to not be a burden on the health care system, among other reasons.

Estimates on this page are derived from the Household Pulse Survey and show the percentage of U.S. adults who delayed getting medical care in the last four weeks or who needed medical care at any time in the last four weeks for something other than coronavirus but did not get it because of the coronavirus pandemic.

Use the drop-down menus to show data for selected indicators or categories. Select the buttons at the bottom of the dashboard to view national and state estimates. The data table may be scrolled horizontally and vertically to view additional estimates.

Technical Notes


Survey Questions

At any time in the last 4 weeks, did you DELAY getting medical care because of the coronavirus pandemic?

At any time in the last 4 weeks, did you need medical care for something other than coronavirus, but DID NOT GET IT because of the coronavirus pandemic?



Estimates on this page are based on responses from adults aged 18 years and over. Persons with missing responses for the characteristics of interest are not shown separately in the tables and are not included in the calculation of percentages.  Therefore, percentages reported here may differ from those available from the Census Bureau website:


Data Source

The U.S. Census Bureau, in collaboration with five federal agencies, launched the Household Pulse Survey to produce data on the social and economic impacts of Covid-19 on American households.  The Household Pulse Survey was designed to gauge the impact of the pandemic on employment status, consumer spending, food security, housing, education disruptions, and dimensions of physical and mental wellness.

The survey was designed to meet the goal of accurate and timely weekly estimates. It was conducted by an internet questionnaire, with invitations to participate sent by email and text message. The sample frame is the Census Bureau Master Address File Data. Housing units linked to one or more email addresses or cell phone numbers were randomly selected to participate, and one respondent from each housing unit was selected to respond for him or herself. Estimates are weighted to adjust for nonresponse and to match Census Bureau estimates of the population by age, sex, race and ethnicity, and educational attainment. All estimates shown meet the NCHS Data Presentation Standards for Proportions.




Weighted Response Rate and Sample Size
Week Weighted Response Rate Sample Size
April 23-May 5 3.8% 68,703
May 7-12 1.3% 39,187
May 14-19 2.3% 118,429
May 21-26 3.1% 89,659
May 28-June 2 3.5% 93,116
June 4-9 3.1% 74,316
June 11-16 2.3% 67,452
June 18-23 2.9% 98,617
June 25-30 3.3% 90,093
July 2-7 3.2% 82,904
July 9-14 3.1% 83,366
July 16-21 2.9% 78,689
August 19-31 10.3% 91,328
September 2-14 10.3% 92,956
September 16-28 9.2% 83,985
September 30-October 12 8.8% 80,179
October 14-26 8.1% 80,719
October 28-November 9 5.3% 48,968
November 11-23 6.6% 60,057
November 25-December 7 6.7% 61,127
December 9-21 6.5% 58,973
January 6-18 6.4% 55,859
January 20-February 1 7.5% 67,169
February 3-15 7.3% 63,964
February 17-March 1 7.3% 64,473
March 3-15 7.4% 64,187
March 17-29 7.2% 63,231
April 14-26 6.6% 55,258
April 28-May 10 7.4% 63,446
May 12-24 6.8% 58,815
May 26-June 7 6.7% 56,953
June 9-21 6.4% 54,726
June 23-July 5 6.3% 53,287



The Household Pulse Survey is different from other surveys. NCHS, the Census Bureau, and other federal statistical agencies are considered the preeminent source of the nation’s most important benchmark surveys.  Many of these surveys have been in production for decades and provide valuable insight on health, social, and economic trends. However, the production of benchmark data requires a relatively long lead time, and personal interviews (face-to-face or telephone) require additional time.  While efforts are underway to introduce COVID-19 questions into these surveys, that process can take months, sometimes years, before data are made available.

The Household Pulse Survey is different:  It was designed to go into the field quickly, to be administered via the web, and to disseminate data in near real-time, providing data users with information they can use now to help ease the burden on American households and expedite post-pandemic recovery.  The Census Bureau is fielding the Household Pulse Survey as a demonstration project, with data released as part of its Experimental Statistical Products Series.

Confidence intervals included in the tables on this page only reflect the potential for sampling error.  Nonsampling errors can also occur and are more likely for surveys that are implemented quickly, achieve low response rates, and rely on online response.  Nonsampling errors for the Household Pulse Survey may include:

  • Measurement error: The respondent provides incorrect information, or an unclear survey question is misunderstood by the respondent. The Household Pulse Survey schedule offered only limited time for testing questions.
  • Coverage error: Individuals who otherwise would have been included in the survey frame were missed. The Household Pulse Survey only recruited households for which an email address or cell phone number could be identified.
  • Nonresponse error: Responses are not collected from all those in the sample or the respondent is unwilling to provide information. The response rate for the Household Pulse Survey was substantially lower than most federally sponsored surveys.
  • Processing error: Forms may be lost, data may be incorrectly keyed, coded, or recoded. The real-time dissemination of the Household Pulse Survey provided limited time to identify and fix processing errors.

For more information on nonresponse bias for the 2020 Household Pulse Survey, please visit


For more information on the Household Pulse Survey, please visit

Suggested Citation

National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2020–2021. Reduced Access to Care. Generated interactively: from