Healthcare Costs Are Squeezing Americans: Here’s Why International Nurses Are More Essential Than Ever

For years, headlines have focused on how expensive healthcare is in the United States. But a recent analysis in JAMA Internal Medicine reveals something even more troubling: the financial strain of healthcare isn’t just a one-time shock for a few unlucky families it’s a long-term burden that most Americans are likely to face at some point in their lives.

For international nurses exploring U.S. nursing jobs or employers recruiting globally, this has big implications. Rising healthcare costs, delayed care, and worsening health outcomes all intersect with one central issue: the need for a stronger, more stable nursing workforce.

At NurseContact a digital marketplace that matches international nurses with U.S. healthcare employers and simplifies the hiring and immigration process we closely follow trends that shape the U.S. healthcare system. Understanding these trends can help both nurses and employers make smarter, more strategic decisions.

What the Study Found: Healthcare Affordability Is a Lifelong Problem

Researchers from Harvard Medical School, Hunter College (CUNY), and Public Citizen’s Health Research Group analyzed data from the Medical Expenditure Panel Survey between 2018 and 2022. They followed 12,645 U.S. adults and looked at several indicators of financial strain caused by healthcare.

They focused on three key measures:

1. Cost burden

• When a family’s out-of-pocket medical expenses exceed 10% of their income
• For low-income households, the threshold is lower: 5% of income

1. Catastrophic cost burden

• When out-of-pocket healthcare costs exceed 40% of a family’s income after basic subsistence needs like food and housing

1. Foregone care due to cost

• When someone needs medical care but doesn’t get it because they can’t afford it

If an individual experienced any one of these high costs, catastrophic expenses, or skipping care they were considered to have encountered financial strain from healthcare.

Over a four-year period, 26.7% of adults reported either a significant cost burden or having to skip care because of cost. That’s more than one in four adults.

Certain groups were at higher risk, including people who:

• Have low income
• Lack health insurance or have gaps in coverage
• Live with chronic illnesses
• Have been hospitalized

One especially striking finding: among the 2.3% of participants who died during the study, more than half (53.2%) had experienced financial strain from healthcare in the one to four years before their death.

Dr. Adam Gaffney, a critical care physician and assistant professor at Harvard Medical School, summarized it clearly: healthcare affordability isn’t a single event it’s a chronic condition that builds over time and eventually touches many Americans.

How High Medical Costs Lead to Worse Health

The study underscores a vicious cycle that nurses see every day at the bedside:

• Patients avoid or delay care because they’re worried about the bill.
• Their conditions worsen over time.
• They finally seek care, often in the emergency department or when severely ill.
• The treatment is more complex, more expensive and more financially devastating.

As Dr. Gaffney noted, “High medical costs don’t just devastate finances, they force people to skip care which often further worsens their health.”

For nurses working in the U.S. and for international nurses considering U.S. hospital jobs this reality shapes clinical practice, discharge planning, and patient education. Nurses are the ones reassuring worried families, helping patients choose affordable options, and recognizing when cost fears are causing non-adherence to treatment.

Why This Matters for International Nurses and U.S. Employers

The financial strain facing patients is only one side of the story. The other side is how the system responds. When patients are sicker and more complex by the time they reach care, the demand for skilled nursing increases.

This is happening in a workforce context where U.S. hospitals, long-term care facilities, and community health centers are already grappling with:

• Persistent nursing shortages
• High nurse burnout and turnover
• Increased acuity and complexity of patients
• Growing needs in chronic disease management, especially for cardiac, renal, oncology, and geriatric populations

Internationally educated nurses are playing a crucial role in closing these gaps. Many U.S. employers are actively seeking:

• International registered nurses (RNs) with strong clinical experience
• Specialty nurses in ICU, med-surg, telemetry, step-down, ER, OR, and long-term care
• Nurses with chronic care expertise, who can support long-term disease management and patient education

This is where NurseContact comes in.

NurseContact: Connecting International Nurses with U.S. Employers

NurseContact is a digital marketplace designed specifically to match international nurses with U.S. healthcare employers that need their skills.

We focus on:

• Streamlining the hiring process
• From initial screening to interviews, offers, and onboarding
• Supporting immigration and visa pathways
• Including EB-3, H-1B, TN (for eligible nationalities), and other employment-based visa options in partnership with employers and legal teams
• Matching nurses to the right facility and specialty
• Hospitals, long-term care facilities, rehab centers, and outpatient clinics across the U.S.

For international nurses, this means:

• Access to real U.S. nursing opportunities with vetted employers
• Clear expectations on salary, benefits, and support
• Guidance through the U.S. licensing, NCLEX, and immigration steps in collaboration with employers

For U.S. employers, this means:

• A pool of qualified, pre-screened international nurses
• Tools to streamline recruitment, interviews, and job offers
• A more predictable pipeline to address ongoing nurse staffing shortages

Connecting the Dots: Patient Financial Strain and the Demand for Nurses

You might be wondering: what does patient financial stress have to do with international nurse recruitment?

They’re more connected than they appear.

As patients skip preventive care and show up sicker, healthcare delivery requires:

• More intensive nursing care
• More chronic disease management
• More care coordination and education

Nurses are central to:

• Helping patients understand medications and follow-up plans
• Identifying when cost is a barrier to adherence
• Coordinating with social workers, case managers, and community resources
• Preventing avoidable readmissions and complications

This increased demand strains the existing U.S. nursing workforce especially in units that care for medically complex, multi-morbid patients. As a result, many employers are turning to international nurse recruitment platforms like NurseContact to stabilize staffing and maintain quality of care.

Study Limitations and What They Mean for the Future

The authors of the study were transparent about some limitations, including:

• Insurance premiums were not included in the out-of-pocket cost calculations, meaning the overall financial burden may actually be higher than reported.
• Nursing home residents were excluded, even though this population often faces very high medical and long-term care costs.

Despite these limitations, the research adds to a growing body of evidence: healthcare costs in the U.S. are not only high they’re persistently undermining both financial security and health outcomes.

As this pressure continues, the need for a resilient, well-staffed nursing workforce will only grow. That includes not only domestic RNs but also international nurses who bring diverse experience, cultural competence, and a strong commitment to patient care.

What This Means for You

Whether you’re an international nurse or a U.S. healthcare employer, this environment presents both challenges and opportunities.

If you’re an international nurse:

• The demand for your skills in the U.S. is real and growing.
• Your experience in managing chronic illness, patient education, and complex care can directly impact patients who may have delayed seeking treatment.
• Platforms like NurseContact can help you navigate the path from your current country to a stable, rewarding nursing job in the United States.

If you’re a U.S. employer:

• Rising patient complexity and financial stress increase the importance of having a strong, reliable nurse workforce.
• International nurses can be a long-term part of your staffing strategy especially when supported through structured orientation, cultural integration, and fair employment practices.
• Using a digital marketplace like NurseContact can simplify recruitment, reduce time-to-fill, and connect you with qualified candidates ready to contribute.

Moving Forward Together

The new analysis on healthcare financial strain is a reminder that U.S. patients are under intense pressure financially and medically. As people delay care due to cost, the system needs more nurses, not fewer.

NurseContact is committed to bridging this gap by:

• Helping international nurses find meaningful U.S. nursing positions
• Partnering with American hospitals and healthcare organizations to build sustainable nursing teams
• Supporting a smoother, more transparent, and more ethical hiring process for everyone involved

If you’re an international nurse looking for U.S. opportunities, or a U.S. employer seeking to strengthen your staffing with global talent, NurseContact is here to help.

Learn more about how NurseContact connects international nurses with U.S. employers and streamlines the hiring process.