Rising healthcare costs are straining budgets and making it difficult for millions of Americans to get the care they need.

Approximately fifty million Americans under age 65 spend more than 10 per cent of their income on healthcare. In 2003, 18.7 million Americans spent more than 20 percent of their income on health care, report Drs. Jessica S. Banthin and Didem M. Bernard of the US Department of Health and Human Services.

The unmanageable expenses can keep many patients from seeking health care until it is too late. For people in poor health, this can have dire consequences.

"We find out that they have cancer or some other chronic disease that could have been better managed if they had had earlier screening," said Dr. Luis Padilla of Upper Cardozo Health Center in Washington, DC.

Soaring medical costs have the greatest impact on low-income families, rural families, middle-aged adults between the ages of 55 and 64, self-employed people, and people with chronic health conditions such as diabetes. The middle class is also being more financially strained than in the past.

People who do not have the advantage of belonging to an employer-sponsored group plan tend to have much higher medical expenses than even those who have no insurance coverage at all.

Health-care costs have been outpacing the rest of the US economy for years, but it has been unclear what effect the changes have had on family budgets.

"We can be sure some expenses are turning into debt. This has access consequences as well as serious financial consequences, such as using up savings or not being able to pay for food or utilities," warns Carol Pryor, a senior policy analyst at The Access Project in Boston.

The report is published in the December 13 issue of the Journal of American Medicine.