Everyone should have the opportunity to have comprehensive health care services and lead a healthy life. To achieve this, people need to have access to the right health care system and have a healthcare provider whom they can have a trusting relationship with. However, there are certain barriers that lead to attaining health care services. Poor access to health care usually results in other problems that include differences in life expectancy, poor health status, and prevalence of chronic diseases. Various barriers to accessing healthcare include the high cost of care, nonfinancial constraints, poor access to care, and lack of health insurance which leads to negative health outcomes.
High cost of care
The high cost of care is one of the reasons people fail to access proper health care. A substantial proportion of the population stated that they were not able to access health care due to costs. The proportion was 33% and they either experienced delays in accessing the health care or did not receive medical care at all. While 33% seems like a big number, the percentage has been on a downward trend since 2013 where 37% of the population did not get recommended care due to cost (Barr, 2016). This shows that fewer Americans are reporting that cost is a barrier to accessing healthcare. The rate of cost-related access problems to healthcare has been falling especially for lower-income Americans. This is largely attributed to the implementation of the Affordable Care Act.
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The high cost of healthcare in the United States can be understood by comparing it with other developed nations. Approximately 7% of adults in the United Kingdom and Germany report a cost-related access problem to access healthcare (Papanicolas, 2018). The prices for health care services in the United States tend to be higher than that of any other countries. Factors that lead to a high cost of accessing healthcare include the high cost of prescription drugs, procedures, physician visits, and tests. The high prices of these services and products drive up the overall cost of accessing health care and health insurance premiums. The high cost of healthcare also drives up health insurance premiums and leads to more people that are uninsured. Residents in the United States thus become highly disadvantaged when paying for care out of their pockets.
Other countries have eliminated the high cost of accessing health care by introducing annual caps on consumer cost-sharing like copayments and deductibles. Some countries provide exemptions for services that are of high-value like that of people with chronic conditions and high-value services like primary care. The average deductible cost for the American individual based on employer plans reached $1,541 in the year 2015 for the United States. This amount is extremely high and would be unheard of in other wealthy nations.
Inadequate or lack of insurance coverage
Health insurance makes a big difference in when and whether people will be able to get the necessary medical care. Uninsured people are more likely to postpone health care or cancel it altogether compared to insured people. The consequences of not accessing healthcare at the right time can be severe especially there are preventable conditions such as a chronic disease that could go undetected.
People without health insurance are more likely to skip prevent services and report that they do not have a regular source of health care compared to people that have health coverage. Studies show that people that are uninsured are three times more likely to state that they have not had a visit to a medical practitioner within the past 12 months. They are also less likely to receive adequate care like recommended screen tests such as colon cancer screening, pap smear, blood sugar screening, cholesterol checks, and blood pressure checks. Another reason why people that have poor access to care is that about half do not have a regular place where they can get medical advice. Most of the insured people have a regular place when they are sick and when they need medical advice. This creates a great ease for people that are insured to get medical assistance and advice when they need one.
Studies show that uninsured children also face challenges in getting the care they need. Compared to any other section of the population, children that are uninsured are likely to lack a source of care, delay their care, and have unmet medical needs. Uninsured children also have injuries and unmet childhood illnesses that do not receive the same level of care like those of insured individuals. They are at a high risk of missed diagnoses for serious health conditions and preventable hospitalizations cannot be treated.
There are proportions of the population that receive gaps in their health insurance coverage. Such gaps in health insurance results in a decreased access to care. Individuals with gaps in their health insurance coverage are less likely to have fewer cholesterol checks and blood pressure checks compared to those people that receive adequate coverage (Sommers et al., 2017). Children that are also uninsured for a part of the year have poor healthcare access problems compared to children that have a full year of coverage. This shows that a short period of coverage improves access to care and a short period of lack of coverage decreases access to care.
Research shows that gaining health insurance improves access to health care considerably and diminishes the adverse effects that result from being uninsured. A seminal study of Medicaid expansion in Oregon found that uninsured adults that gained Medicaid coverage get more likely to receive prescriptions and have an outpatient visit. This proportion of the population becomes less likely to have stress and depression in the short term compared to people that received adequate coverage. Findings from the study showed that significant improvements in utilization and access to health care improved when individuals gained healthcare coverage (Baicker et al., 2014).
Community clinics, public hospitals, and healthcare centers provide a safety net for people that are uninsured, but the safety net does little help in closing the access gap for people that are uninsured. Initiatives such as community health centers, local health departments, and community hospitals provide care for people that are without health coverage. Additionally, all hospitals and private physicians provide charity care. However, the proportion of care provided by these practitioners have limited capacity and resources to serve all uninsured people. The Affordable Care Act saw a significant increase in the number of health care centers and the service capacity through grant funds and improved patient revenues. However, the impact has become somewhat limited in states that do not have an ever-increasing Medicaid where a large proportion of the population is uninsured (Muennig et al., 2015). The result is that a large proportion of the population that are uninsured still have difficulty in access to adequate healthcare.
Lack of availability of services
The lack of availability of health care services is a problem that people in rural residents face. People that live in farm and rural areas have lower access to health care in terms of affordability, quality, and proximity compared to people in urban populations. People in nonmetropolitan households also have a higher chance to report that the cost of healthcare limits the ability to receive adequate medical care. People in remote countries have to travel long distances to get specialized treatment. These patients may also substitute local primary healthcare practitioners for specialists. They can also decide to forego care from a specialist due to the time taken to travel and burdens of costs.
People in rural areas have to travel long distances in order to see a specialist or have access to healthcare services. This presents a very big burden in terms of money and time to access healthcare. The lack of adequate transportation services also presents a big barrier. This is different in urban areas because public transit is a viable transportation option for patients to get medical appointments. The large proportion of residents in rural areas are elderly people that have chronic conditions and require multiple visits to healthcare facilities. It becomes challenging especially when there are no private or public transportation systems.
Nonfinancial barriers
Examples of nonfinancial barriers that limit access to health care include accommodation, availability, accessibility, and acceptability. Accommodation involves being busy with work and other commitments. Availability involves not getting an appointment from a healthcare practitioner soon. Accessibility occurs when one takes too long to get to the clinic or the doctor’s office. Acceptability occurs when the hospital or doctor would not accept the health insurance of an individual. Accommodation and availability barriers are more prevalent in women while more whites had acceptability and availability barriers. More blacks reported accessibility barrier where they found it too long to get to the doctor’s clinic or office.
The most common nonfinancial reason for not getting medical care is that people are too busy and working with other commitments. The result is that people are not able to get to the doctor’s office when it is open and thus cannot get an appointment soon enough. Many also have a problem of taking too long before they get to the doctor’s office. Research shows that a large percentage of adults that experienced nonfinancial barriers also had an affordability barrier. Approximately two-thirds of people that find trouble affording care also report nonfinancial barriers (Kamimura, 2018).
Effect of the lack of insurance on health outcomes
The lack of insurance plays a big role in determining several negative health outcomes for people that are uninsured. Uninsured patients are less likely to have the necessary follow-up and screening for different health-related ailments. They thus have an increased risk of being diagnosed at the later stages of diseases. Diagnosis of diseases such as cancer at the later stages leads to higher mortality rates for individuals without insurance. Additionally, when uninsured people become hospitalized, they receive fewer therapeutic and diagnostic service and thus have higher mortality rates compared to people with insurance.
The underlying idea of the Affordable Care Act is that people that have health insurance will be healthier. For instance, people with insurance will find it easy to be diagnosed with diabetes and have the right drugs prescribed to manage the disease. Insured people will also realize early that they have high blood pressure or high cholesterol and get adequate medical treatments and advice in order to prevent heart diseases. Health insurance thus affects the health outcomes of an individual in the long-term.
Policies have to be put in place to organize the health care system in a way that improves access. The issue of financial constraints should be dealt with comprehensively because it is one of the main barriers to accessing adequate healthcare. Various endeavors should be put in place to ensure that a large percentage of the population is insured. To prevent other nonfinancial barriers, a program such as the offering of evening and weekend health services would make it easier to get appointments with healthcare providers. Telemedicine and email communications and providing incentives for people that work in underserved areas should be implemented to improve the care. There is a need to provide adequate federal support for the care so as to ensure that people are financially covered and that the healthcare systems are relevant and provide care in a meaningful way.
References
Baicker, K., Finkelstein, A., Song, J., & Taubman, S. (2014). The impact of Medicaid on labor market activity and program participation: evidence from the Oregon Health Insurance Experiment. American Economic Review , 104 (5), 322-28.
Barr, D. A. (2016). Introduction to US Health Policy: the organization, financing, and delivery of health care in America . JHU Press.
Kamimura, A., Panahi, S., Ahmmad, Z., Pye, M., & Ashby, J. (2018). Transportation and other nonfinancial barriers among uninsured primary care patients. Health services research and managerial epidemiology , 5 , 2333392817749681.
Muennig, P. A., Quan, R., Chiuzan, C., & Glied, S. (2015). Considering whether Medicaid is worth the cost: revisiting the Oregon Health Study. American journal of public health , 105 (5), 866-871.
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States and other high-income countries. Jama , 319 (10), 1024-1039.
Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health—what the recent evidence tells us.
