Disparities in Access to Health Care in the United States
The U.S. health care system is envied around the world, but despite expanded coverage under the Affordable Care Act (ACA), there is still significant disparity in access to adequate health care. Social determinants of health (SDOH), and other factors, including transportation, affordability, and scheduling difficulties, create challenges for people seeking medical care with negative effects on population health. Can the health care system overcome access inequity?
Social determinants of health (SDOH)
According to the Centers for Disease Control (CDC), “SDOH are conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.” This includes the geographic area where an individual resides, race, ethnicity, economic status, age, sex, native language, housing, education, nutrition, and disability status. Childhood exposure to violence or drug abuse in the home, substandard housing, dropping out of school, or nutritional deficiencies are also often linked to poorer health outcomes.
Access to timely and adequate personal health services is another critical determinant of health. Access means the ability (i.e., finances, transportation, opportunity, etc.) for patients to get to the healthcare facility and meet with a provider who can deliver the specific health services required. For most of us, access to a health care facility doesn’t present a problem. But for people in rural areas, those without reliable transportation, financial resources, insurance, and/or available time off work to keep an appointment — accessing health care remains a challenge.
Barriers to health care access
Although our health care services are among the best in the world, we still have a long way to go in addressing barriers to health care access. In addition to SDOH, other challenges limit certain populations from accessing consistent care. These include:
Scheduling. Providers who observe traditional 8 to 5 workdays make it difficult for some full-time workers to schedule appointments that don’t conflict. The ongoing health care staff shortage makes things even more challenging.
Affordability. Rising health care costs mean increased out-of-pocket expenses. A growing number of people lack health insurance or can’t keep up with increasing premiums.
Transportation. People who live in remote or rural areas without access to a vehicle or public transportation will often forego preventive care or routine exams.
Barriers to accessible, preventive health care contribute to increases in infant mortality, chronic disease, and poor health outcomes — as well as increasing health care costs overall.
Improving access
For patients suffering from chronic disease, access to health services is crucial for optimal outcomes. Providers and health care facilities have a responsibility to do what they can to improve patient access. Here are some measures they can take to improve access.
Scheduling. Modify hours to add nights and weekends, and expand the workforce by hiring more staff so more appointment opportunities are available.
Transportation. Partner with a ridesharing service such as Lyft or Uber to provide transportation for clinic visits or emergency transport.
Affordability. Be proactive and transparent about the price of services, so patients can decide which options are suitable for their care and budget. Also offer personalized payment plans to help patients spread out payments.
Telehealth. Options such as patient portals, digital recordkeeping and sharing, and telehealth appointments reduces many access barriers for people who can’t travel long distances.
Equal access across populations. Continually measure clinical outcomes for equity of care across all socioeconomic, racial, and ethnic boundaries.
