There’s a long list of reasons why you might delay a trip to the doctor’s office or hospital.

Maybe you can’t find a ride. Maybe you need to work instead. Maybe it’s just too expensive.

A new study by researchers at Harvard University and Brigham and Women’s Hospital in Boston shows there’s more evidence that people in Berkeley and Colleton counties are delaying treatment specifically because of high health care costs at a higher rate than adults in Charleston and Dorchester counties. The results were published in the New England Journal of Medicine last week. The study analyzed county-level data across the nation.

“Particularly vulnerable areas were in the South, including Texas and Florida” because Medicaid eligibility requirements in those states are stricter, the study found. Locally, the study estimated between 19.8 percent to 40.6 percent of adults in both Berkeley and Colleton counties are waiting to seek treatment because of the cost. In Charleston, that rate is between 17.2 percent and 19.7 percent.

Dorchester County’s rate was the lowest in the tri-county area — between 15.4 percent to 17.1 percent of adults there wait to seek treatment due to cost. The study also found a higher rate of delayed care in areas with fewer primary care doctors, more Hispanic residents, lower income levels and a higher prevalence of chronic disease.

“I think that the states that appear to have the highest rates are the states have the least investment in insurance and infrastructure. That’s not surprising,” said Dr. Jennifer Haas, a professor at Harvard Medical School and one of the study’s authors. In South Carolina, adults who are not disabled or pregnant do not qualify to enroll in a Medicaid plan, regardless of their poverty level.

The federal Patient Protection and Affordable Care Act allows states an option to expand Medicaid to more uninsured adults in 2014, but Republican lawmakers, including Gov. Nikki Haley, have said the state will not participate.

Tony Keck, director of the state Department of Health and Human Services, an opponent of Medicaid expansion, said he wasn’t surprised by the study results, either.

“It confirms a lot of what we know about health care and the trick has always been … when prices are artificially low for health care because of subsidies or because people aren’t connected to the price, they many times use too much health care, but other times, when prices are too high, people don’t use enough health care.”

Keck doesn’t think expanding Medicaid will help. Health care is already too expensive, he said, and South Carolina’s health outcomes don’t justify spending billions more on a program that isn’t working well enough.

He cited another study published in the journal Health Affairs in March that shows mortality rates for females in many parts of the country have increased or stagnated since 1992.

Researchers from the University of Wisconsin-Madison determined “our results underline the lack of value obtained from ever-increasing health care expenditures.”

“What’s common to both of those studies? High cost of health care,” Keck said. “That’s why we’re so focused on pushing down the amount of spending.”

Rozalynn Goodwin, director of policy research at the South Carolina Hospital Association, a pro-Medicaid expansion group, disagrees with Keck that expanding the health insurance program for the impoverished won’t make South Carolinians healthier.

“We’ve got a lot of people in poverty who don’t have insurance. Insurance is expensive. Health care is expensive and when you’re low means, it’s not as easily accessible,” Goodwin said.

“Until we do all we can to do in our state to expand coverage, we’re going to continue to be on the wrong end of these national studies that are coming out.”