What are Barriers to Access in Healthcare?
The key barriers in healthcare for accessibility include language, financial, attitudes, and also physical and logistical barriers. As a point of contention among partisan political groups, the healthcare crisis in America has been clouded by competing agendas. Specifically, the media’s focus is on large insurance carriers and legislative actions taken by the state like the Affordable Care Act. However, little or no credence is paid to the many social and cultural nuances that affect one’s access to healthcare. While the cost of healthcare services and the structure of our healthcare reimbursement system certainly contribute to lack of access, many social barriers that prospective patients face are being overlooked. As such, this report will comprehensively review both the financial and social barriers to healthcare.
Patient Education and Attitudes
Regardless of how affordable healthcare is, if a prospective patient is unwilling to seek it out because they are misinformed as to the nature and severity of their own condition, then their needs will remain unmet and their condition may worsen. A qualitative study published in the Journal of General Internal Medicine reported that 12.2% of participants stated they avoided doctor’s visits because they believed that their symptoms would improve on their own. This effect is compounded when the patient’s symptoms are generic, like nausea and fatigue. What may be a serious illness (i.e., gastric cancer) is often dismissed as a more commonplace one.
Additionally, cultural and social motivators can increase disparities in healthcare for certain groups. For example, the gender socialization of men in many cultures discourages them from admitting that they are in pain, so they often opt to avoid the doctor when they should go in for an evaluation. Certain cultures and religions rely on alternative and/or spiritual healing methods that exist fully outside of modern healthcare systems. Finally, many Americans are rallying against the pharmaceutical companies, a trend responsible for the anti-vaccination movement and less radical forms of healthcare avoidance, like homeopathic remedies and self-lead therapies.
General Accessibility and Availability Barriers
Even if a patient overcomes the above social barriers that may prevent them from seeking healthcare, the issue of accessibility can still be threatened by more logistical obstacles. For example, patients who rely on public transportation, or who live in remote areas, may not be able or willing to travel long distances or catch the bus to visit a doctor.
Conversely, patients who have a steady means of transportation may still experience a lack of access to healthcare services. This may simply be because the resources in their area do not support their particular condition. Medical tourism is a term referring to people who have to travel long distances to see specialists. Travel requires patients to spend the extra money and possibly miss multiple days of work for treatment.
Depending on the patient’s situation, lists of barriers to healthcare access can include many other logistical obstacles.
- Inability to pause work or family obligations.
- Inconvenient facility hours.
- Long waiting periods (especially surgical consult).
- Uncertainty when transitioning from one provider to another.
For low-income patients, the above barriers are more potent and prevalent. Additionally, low-income patients often rely on a rotating selection of emergency rooms and clinics. This invites opportunities for miscommunication between the inconsistent stream of healthcare providers. Subtract health insurance from this equation, and the barriers to healthcare access are all but insurmountable.
Currently, there are more than 40 million Americans with no health insurance. Additionally, at least 35 million more are denied care because their medical provider did not accept their insurance. Researchers and lobbyists have groomed this audience into a monolith. They cite poverty as the cause for the coverage gap while ignoring the many other factors in play. Yes, healthcare costs are increasing and fewer Americans can afford adequate health insurance. However, the problem is complex and there are many political, legislative, and social barriers.
Almost a third of polled Americans, for example, believe that Obamacare was replaced by the Trump administration, which has decreased the number of people signing up at Healthcare.gov. State-level updates to Medicaid, as in Indiana and Arkansas, require low-income policyholders to fulfill mandatory work requirements, also contributing to the coverage deficit. The financial penalty imposed on uninsured Americans is in the process of being dissolved. All of these changes have contributed to the loss of healthcare coverage deficit.
Language Barriers and Citizenship
Low-income immigrant populations are especially susceptible to healthcare disparities. This disparity is because they face a number of additional challenges when attempting to access the American healthcare system. Chief among these challenges is the language barrier. Patients who don’t speak English may have access to translated medical documents and live interpreters. These resources are often inconsistent. If a patient needs to make a follow-up appointment, for example, or change providers, they often have difficulties because of interpreter availability. Providers translate test results off-site or at all. This prevents patients from asking their doctor for clarification of technical terms.
Many new residents have limited healthcare coverage because of their citizenship status. Medicaid, for example, is not available to lawfully residing immigrants until a 5-year period has passed. Some states are beginning to relax this requirement in cases of urgently needed care, but other, similar restrictions continue to limit access.
Solutions for Barriers in Healthcare
Like all important social work, the comprehensive nature of this review is not intended to paint a grim picture. Rather, it is to expose the network of subtle, social barriers that constitute the root of the problem. Throwing money at the problem indiscriminately with increasing government funding, will only increase the healthcare disparity. The change will come only when if the social barriers to access are eliminated. Policy solutions come with targeted and thoughtful intervention. Then healthcare resources and the people who need them can be reconciled in a lasting and efficient manner.