Five Key Barriers to Healthcare Access in the United States – Wolters Kluwer

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To address systemic inequity, health systems need to confront and overcome several healthcare barriers to patients receiving quality and equitable care.
According to a new Deloitte report, by 2040, the cost America pays for its barriers to healthcare access could surpass $1 trillion. The report analyzes impacts across several “high-cost diseases,” including cancer, diabetes and heart disease.
The most alarming cost is the number of lives at stake. Many people can’t afford to see the doctor; some do not even have one nearby. Addressing these and other top barriers to healthcare access has become mission-critical across the care continuum. But as stakeholders are learning, it won’t be easy.
Healthcare disparities exist across a spectrum of financial, geographic, cultural and social challenges. As leaders assess their roadmaps toward more equitable care, they should consider multifactorial solutions for these multifactorial problems. The challenges are myriad, but five are especially concerning for the years ahead.
A lack of insurance often contributes to a lack of healthcare. This challenge is dire and far-reaching: Financial need and insufficient coverage to pay medical bills can lead people to skip necessary care for themselves and their families, including preventive screenings, dental care and pediatric visits that track important childhood health milestones. The lifetime health consequences of missing these appointments have prompted many health systems to launch initiatives that provide services to uninsured or underinsured patients.
By 2034, The Association of American Medical Colleges estimates that the American healthcare system could be up to 124,000 doctors short, with roughly a third of those deficits in primary medicine. But it’s not just physicians that will be lacking — nurses, technologists and other roles have predicted shortfalls as well. These gaps affect everyone, but particularly patients already in “healthcare deserts” such as rural areas. In response, many experts have called for expanded technology uptake — from telehealth to patient engagement — to increase providers’ capacity and address the gaps.
Stigma and bias exist across the medical community, including discrimination based on race, immigration status, sex, gender and sexual orientation. A 2020 paper from the American College of Physicians outlines how stigma hampers access to care, affecting patients’ willingness and ability to seek specialized support such as mental healthcare services or hormone replacement therapy. Even unintentional bias from clinicians and staff from outdated medical materials makes patients feel unwelcome and reluctant to return. Health leaders are using clinician education to fight back, making inclusion an emerging topic in continuing medical education offerings and other resources.
In the same paper that discusses stigma and bias, the American College of Physicians cites transportation and work-related concerns as a key limit on patients’ ability to access preventive care and treatment. Specific obstacles include an inability to travel into city centers or take the required time off.
Where clinically possible, telemedicine can help alleviate these concerns. Some health systems have also developed shuttle systems and after-hours services to expand access.
1 in 5 US households speaks a language other than English at home; meeting patients’ language needs is a growing concern for health systems. When patients and clinicians don’t speak the same language, it can impact the quality of care individuals receive, especially in hospital settings. While many patients involve family members as their interpreters, doing so can risk miscommunication and mistranslation. Instead, a Nursing Management paper suggests involving professional medical interpretation services and using multilingual patient education to better support patients.
Health systems are confronting these and other barriers simultaneously with operational ones, such as labor shortages, financial strains and policy changes in an evolving industry. As healthcare leaders work to improve population health within those constraints, they are harnessing the power of technology to help, from clinician education to telehealth. Access concerns are significant, but with specialized tools and engaged stakeholders, a better future is possible.
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