Barriers to care are factors that keep people from seeking or receiving healthcare services. People may have multiple factors that hinder their ability to get care. By identifying and removing these barriers, we can increase the number of people who do have access to care. By doing so, more people will have preventative care, can be diagnosed and treated earlier in disease progression and ultimately experience an enhanced quality of life.
What are the barriers to care?
There are a wide range of issues that keep people from getting the care they need in the U.S. From systemic challenges to personal choice, people end up delaying care for a number of reasons, even in the most critical circumstances. Key themes for these barriers center around lack of time, lack of money, illiteracy, and lack of access.
Here are eight common barriers to care that people in the U.S. face today:
Insufficient insurance coverage
Nearly 30 million people don’t have any medical insurance coverage in the U.S. That’s almost 1 in 10. The idea of walking out of the hospital with a bill for thousands of dollars is overwhelming for many of them, so they avoid seeking care unless it becomes dire.
Even for patients who do have insurance, depending on what type of health plan the person has, often only a portion of the doctor’s visit, procedure or hospital stay may be covered, leaving the patient to pay the remainder. This may make the person avoid seeking care when they need it, even while having insurance coverage. For example, a person goes to urgent care and is told the visit will cost $200. They have not yet had any claims towards their $500 deductible so they would be required to pay the full $200. This may result in the person walking out of the urgent care center without getting the care they needed.
On top of any out-of-pocket visits costs, a patient may also be facing prescription drug costs. With approximately six in ten adults on at least one prescription medication, many are aware of how costly these drugs can be. When money is tight, people will often forgo their medication in lieu of buying groceries, or paying bills.
Staff shortages and geography
It matters where you live. A growing shortage of clinical healthcare workers has now become one of the nation’s top patient safety concerns. These shortages contribute to challenges to access to care, creating ‘healthcare deserts’ around the country where people have to drive over 30 minutes to the nearest primary care doctor or hospital.
Primary care physicians, registered nurses, home aides, midwives, physical therapists, mental health professionals, and additional professional roles are all predicted to have shortfalls in the next several years. There are several reasons behind these shortages including the high cost of medical school, increase in the aging population, higher acuity levels, increasing number of people seeking mental health service and more.
Stigma and bias
Stigma and bias in the medical community toward patients can be a major barrier to getting the care they need. Discrimination based on race, immigration status, sex, gender, and sexual orientation are all serious issues that require acknowledgement and implementation of processes that result in more equitable care.
Provider populations often do not reflect the community population, resulting in a care delivery system that does not recognize barriers that stem from differences in culture, race, age, gender, disability, religion and other factors, and therefore does not provide solutions to these issues. Studies show improved patient outcomes and patient satisfaction when physicians recognize cultural nuances, traditions, and implications in the populations they serve.
We also see stigma and bias towards mental illness play a large part in people feeling reluctant to seek the mental health services they need. This labeling and stereotyping can make people feel isolated and ‘not normal’ when, in fact, there are millions of people facing mental health issues.
Lack of transportation
A lack of transportation can result in missed or delayed health care appointments, poorer health outcomes, and increased healthcare costs. Millions of people take public transportation and are dependent on existing routes that may not go where they need. It also greatly affects seniors and the disabled who may not be able to drive.
Most healthcare practices are open during the same daytime hours that people work. This means that people must request off work necessary to travel to and have their visit. Many hourly workers may have to sacrifice their pay for the hours they are no longer able to work.
Patient language barrier
22% of the population (roughly 60 million) do not speak English at home. Having a provider that does not speak the same language as the patient can result in miscommunication, unclear instructions, and poorer outcomes.
A new diagnosis, treatment options, insurance coverage, medication instructions… it’s not always easy to understand or make decisions on these issues. The U.S. healthcare system is complex and can be confusing even for those working in it. This lack of comprehension may result in poor outcomes due to either delayed care or lack of adherence to treatment instructions.
6 benefits of removing barriers to care
Removing barriers to care can benefit patients, employers, payers, and overall population health in the U.S. Here are a few key benefits of removing barriers to care:
- Improved patient outcomes and quality of life
- Increased trust and utilization of healthcare services
- Prevention of disease or worsening of conditions
- Increased patient experience and satisfaction
- Reduction in healthcare costs
- Increased productivity as an employee, family provider, member of society, etc.
How healthcare organizations are removing barriers to care
So now that we have identified barriers to cae, how do we provide solutions? Health systems, accountable care organizations, patient-centered medical homes, and numerous other healthcare organizations are taking the initiative to develop innovative programs that tackle critical barriers for their population.
Popular initiatives to remove barriers to care include:
- Telehealth and remote patient monitoring for those living in ‘healthcare deserts’ or have a tough time getting transportation
- Enhanced patient questionnaires to identify barriers to care
- Medical scribes to reduce admin work for primary care physicians
- Free preventive care clinics to get annual check-ups, immunizations, and screenings
- Education and training to reduce stigma and bias and promote diversity, equity, and inclusion
- Health system-sponsored shuttle systems
- After-hours and weekend clinics
By thinking outside-of-the-box and taking the time to identify barriers to care, healthcare professionals can create strategies that improve population health and target underserved populations with the care they need most.
Nurse leadership: 4 strategies to positively lead through change
3 critical workforce challenges in healthcare right now
Ethics in healthcare — strategies and tips for improving patient-centered care
The National Association of Latino Healthcare Executives (NALHE) and Dignity Health Global Education (DHGE) are aligned in their mission to increase access to high-quality education and equity in healthcare