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 (i.e., the Affordable Care Act). 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 lack of access to healthcare services because the resources in their area do not support their particular condition. “Medical tourism,” a term referring to people who have to travel long distances to see specialists, requires patients to spend extra money to travel 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, such as:

      • 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.

Financial Barriers

Currently, there are more than 40 million Americans living without health insurance, and at least 35 million more who have been denied care because their insurance was not accepted by a medical provider. Researchers and lobbyists have groomed this audience into a monolith, citing poverty and little else as the cause for the coverage gap, while ignoring the many other factors in play. Yes, healthcare costs are increasing, and fewer Americans are able to afford adequate health insurance, but the problem is also fueled by a complex web of 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 State-level updates to Medicaid, as in Indiana and Arkansas, require low-income policy holders 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 healthcare coverage deficit.

Language Barriers and Citizenship

Low-income immigrant populations are especially susceptible to healthcare disparities 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. Diagnostic imaging results are often translated off-site, if they’re translated at all. This prevents patients from asking their doctor for clarification of technical terms.

New residents especially are often limited in their healthcare coverage because of the legal stipulations surrounding 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.

Like all social work worth supporting, the comprehensive nature of this review is not intended to paint a grim picture, but to expose the network of subtle, social barriers that constitute the root of the problem. Throwing money at the problem indiscriminately, i.e., increasing government funding, will only increase the healthcare disparity if the groups experiencing social barriers to access are not addressed specifically. With targeted and thoughtful intervention, healthcare resources and the people who need them can be reconciled in a lasting and efficient manner.

Tim Kalantjakos

B.S. Sociology | University of Nebraska at Omaha

A.S. Physical Therapy | Clarkson College

July 2019