November 18, 2023
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When patients have access to health care, they are empowered to build beneficial relationships with providers and ultimately manage and overcome illness and injury. Without that access, people live with undue pain and conditions that tend to worsen over time.
Many in the United States do not have ready access to health care — and the barriers they face are not of their own making. Between high insurance costs, inadequate transportation systems and appointment availability issues, potential patients often encounter insurmountable obstacles to the health care they need and deserve.
Learn how to improve access to health care — saving time, money and lives — by expanding health care throughout the U.S.
What Are Some Problems with Access to Health Care?
Health care is not equally accessible across the country. Consider the following three problems that can prevent individuals and families from accessing vital care:
1. High Health Care Costs
High out-of-pocket costs, even for patients with insurance, are a huge barrier to accessing health care. When people must choose between paying for food and rent or paying for health care, many forgo health care. It’s an unacceptable choice disproportionately forced onto people from low-income families.
Around 30% of Americans cite high out-of-pocket health care costs as a barrier to treatment, according to a December 2021 West Health and Gallup poll.
High health care costs are an especially pernicious problem in the U.S. relative to other countries. The U.S. has the starkest income-based health disparities, when compared to other developed nations, according to a 2020 report from The Commonwealth Fund reported in Health Affairs. The study found that 38% of U.S. adults had skipped some form of health care (i.e., a test, treatment, visit, or prescription fill) in the past year due to financial burden.
While people who are below the poverty level may be able to access free or low-cost health care options, those that live at a level above the poverty line and even in the middle class income bracket may not be able to afford health care, even if they can access it. Rising costs for medical care are putting it out of reach for many. Couple this with the growing number of high-deductible plans, which require people to pay quite a bit out of pocket before the insurance kicks in, and you have an economic situation that requires many people to turn away from needed health care just because of the cost.
2. Transportation Barriers
Transportation barriers significantly impact whether people have access to health care in the U.S. — such as being able to make it to their medical appointments.
People living in rural areas, where public transportation and internet services might be limited, may need to travel far distances to receive care. Cancer patients requiring radiation treatments traveled around 40.8 miles, on average, from rural areas in contrast to those who traveled around 15.4 miles, on average, from urban areas, according to research published in The Journal of Rural Health.
Those who can drive must take time off work and spend money on gas to access treatment and care. This quickly becomes challenging for those living with chronic illnesses who need regular care. Approximately 46 million people in America live in these types of rural areas, according to the Economic Research Service program with the USDA, so this means many are left without the access they need.
Transportation issues affect people in suburban and urban regions, as well. People with mobility challenges may have a difficult time leaving their homes to access care, and providers located in areas with inadequate public transportation may be inaccessible for lower-income patients and patients who do not own vehicles.
3. Implicit Bias and Health Care Avoidance
Living as a person of color in the U.S. correlates with poorer health outcomes, according to the social determinants of health — a framework for understanding how external variables such as where a person lives and how much education they have attained affect their health outcomes. For instance:
- Infant mortality rates are 2.3 times higher for Black infants compared to white infants, according to the U.S. Department of Health and Human Services.
- American Indian, Alaska Native, Hispanic and Black individuals have significantly higher rates of diabetes compared to non-Hispanic white individuals (14.5%, 11.8%, 12.1%, and 7.4% respectively), according to the Centers for Disease Control and Prevention.
- People of color experience higher COVID-19 infection rates and poorer outcomes compared to white people, according to the Centers for Disease Control and Prevention.
While many factors contribute to these disproportionately negative outcomes, one involves the way that people avoid interactions with health care providers if they expect they will experience discrimination and racial bias. For example, 10% of Black patients reported discrimination during a health care encounter, according to April 2021 data from the
Robert Wood Johnson Foundation and the Urban Institute.
The lack of cultural competency and respect that a person of color may experience when seeking medical services can dissuade entire communities from pursuing health care, with word-of-mouth anecdotes about racially biased interactions with health care professionals instilling fear and anxiety.
Accessibility to Health Care: 5 Potential Solutions
Regardless of their leadership style, effective health care leaders understand the value of looking to research when trying to tackle multipronged issues like accessibility to health care. Consider the following five evidence-based approaches to improving access to health care.
1. Expand Insurance to Cover Health Care Costs
31.6 million people of all ages were uninsured in 2020, according to The National Center for Health Statistics. These people are often employed individuals or dependents of employed individuals — including 3.7 million uninsured children.
There are many reasons for this growing trend. As the cost of insurance continues to rise, many companies are no longer able to offer it as a benefit to their employees. Shopping for insurance in the private market often leaves people with expensive policies and high-deductible plans. For some, this is an expense they simply cannot afford.
One major effort to expand insurance coverage and access to health care in the U.S. has been the expansion of Medicaid. This process, while complex, has increased health care accessibility for many. In January 2020, 35 states and the District of Columbia had expanded Medicaid. The result? Adults ages 18 to 64 years old living in Medicaid expansion states were more likely to be insured, more likely to have private insurance and more likely to have public coverage compared to adults living in non-expansion states, according to The National Center for Health Statistics.
Government initiatives designed to help uninsured individuals secure health care coverage through state and federal programs are helpful in lessening the impact of uninsured status as a barrier to health care coverage.
2. Extend Telehealth Services
Historically, providers have been unwilling to establish services in small, rural communities because they lack large hospital systems and populations with money to pay for services. Those that do have clinics in small rural towns may not have the latest technology to offer the highest level of care. This means people have to travel away from their home community to get medical care.
Telehealth provides remote access to physicians and other medical service providers to patients without a physical clinic in their area. Through videoconferencing and cloud-based data, doctors can communicate across large geographic distances to better coordinate care for patients. In rural areas, telehealth allows small-town doctors to connect their patients with specialists to help them provide better overall care. Once the technology is in place, it’s also a more affordable option for those facing cost concerns. It can eliminate the need to travel to the doctor for routine checks, giving patients the power to connect remotely for these checkups.
3. Invest in Mobile Clinics
To address issues with transportation due to geographic barriers and improve access to care, the U.S. health care system is increasingly investing in alternative treatment sites. Instead of traveling to a hospital, many patients can now access care at mobile clinics closer to where they live and work.
For example, during the COVID-19 pandemic, many states deployed mobile clinics built inside of vans and trailers to rural areas — providing testing and treatment resources for communities with limited access to health care services. Patients were able to drive up to these clinics and seek care while staying inside their vehicles.
Another example is the rise of free-standing emergency departments. These provide emergency services so that those in communities that lack a hospital can get urgent care when needed.
4. Educate the Public About Multiple Health Care Sites
Visits to emergency departments (EDs) are especially expensive in the U.S. Because of their cost, many people who need emergency care (patients with “high-acuity cases”) forgo treatment. Paradoxically, many other patients seek emergency care when it is not necessary, due to a lack of awareness about less costly care facilities.
Patients need better education about where they can — and should — seek care, depending on their symptoms. This requires an understanding of the different services provided at primary care facilities, urgent care facilities, and emergency rooms.
5. Improve Cultural Responsiveness
People may not seek medical attention if they fear that they will be mistreated or otherwise disrespected by a medical professional.
To reduce implicit bias in health care, leaders must continue to devote efforts to training staff in cultural competency and to creating policies that do not perpetuate racial bias.
Health care providers can take additional steps to ensure the comfort and well-being of their patients by getting to know their patients as people; at the beginning of a visit, providers should ask questions in a warm tone and offer opportunities for patients to share their concerns in a safe environment.
In addition, care facilities can take measures to expand translation services, as needed, for areas with bilingual and trilingual populations.
Bringing Health Care to Patients in Need
After examining some of the many ways to improve access to health care in the U.S., you may be interested in pursuing a career in health care leadership. Those who are ready to spearhead change in the medical field should consider USC’s executive MHA. An EMHA degree can help prepare clinicians, executives and managers to make health care more affordable, accessible and equitable. Learn more about how USC can help you shape your career to transform the business of health care.
Sources:
Centers for Disease Control and Prevention, Prevalence of Diagnosed Diabetes
Health Affairs, “Income-Related Inequality in Affordability and Access to Care in Eleven High-Income Countries”
Health Affairs, “Public Transportation in the US: A Driver of Health and Equity”
The Journal of Rural Health, “Evaluating Travel Distance to Radiation Facilities Among Rural and Urban Breast Cancer Patients in the Medicare Population”
National Center for Health Statistics, Health Statistics: Measuring Our Nation’s Health
National Health Statistics Reports, “Demographic Variation in Health Insurance Coverage:
Patient Engagement HIT, “Top Challenges Impacting Patient Access to Healthcare”
U.S. Department of Agriculture, “Rural America at a Glance 2021”
U.S. Department of Health and Human Services, Infant Mortality and African Americans
