Unless you live in the south or work remotely from a tropical island, the weather right now is probably very cold. Some areas of the United States have been hit with copious amounts of snow, while others are experiencing temperatures near zero.
Although it can be an inconvenience, especially for outdoor plans, cold weather doesn’t usually prohibit access to healthcare for most children and adults. Patients might delay preventive services and non-urgent care until the area around them begins to thaw, but they don’t go for months without seeing their doctor to deal with chronic disease and other conditions.
Unfortunately, there are several barriers to care that make it difficult or nearly impossible for some Americans to access care — with cost of care at the top of the list. As we mentioned in a recent blog, just under two-thirds of respondents to a Gallup poll said they are increasingly worried about the cost of overall healthcare services.
Other obstacles keeping some individuals from accessing care include lengthy appointment wait times, limited appointment availability and office hours, provider shortages, lack of transportation, language barriers and even racial bias. If and when these issues aren’t addressed, patients are at increased risk for gaps in care, a lack of preventive care, poor management of chronic disease and worse health outcomes.
Worrisome Wait Times
According to the Medical Group Management Association (MGMA), median patient total wait times — including time spent in the waiting area as well as in the exam room waiting to see a provider — range from 20-25 minutes. Lengthy wait times can be very vexing for patients, especially when they’re in a room crowded with sick people.
A less often discussed healthcare wait time is the delay experienced by patients in getting in to see their provider. Recent data shows that it takes an average of 20.6 days for a patient to get an appointment with a family physician, even longer for specialists. For primary care, the average time to the third next available (TNA) appointment is 16 days for new patients and 12 days for established ones.
Wait times for an appointment are a problem, too, for patients attempting to access care for mental illness. Untreated mental health conditions can result in unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and poor quality of life.
Inadequate Office Hours
Convenient provider office hours are preferred by some patients and required by others. Some patients are only able to access care on nights and weekends when the only care option is a retail clinic, urgent care center or the emergency department. Connecting patients with the right care at the right time is an essential component of value-based care but one that’s not always possible with limited scheduling.
Problematic Provider Shortages
Eighteen percent of healthcare staff have quit since the beginning of the COVID-19 pandemic. However, shortages of healthcare providers were an issue before that, with a patient-to-primary care physician ratio of 53.3 physicians per 100,000 individuals in urban areas. The lack of providers in rural issues has long been well-documented, and shortages in mental health services are widespread.
The American Association of American Medical Colleges (AAMC) estimates a national shortage of between 37,800 and 124,000 physicians by 2034. Overall healthcare staff shortages are projected for every state by 2026 when the U.S. will lack an estimated 3.2 million healthcare workers.
Patients who are able to overcome other obstacles in access to care sometimes still have trouble locating a qualified healthcare provider. They are often limited by insurance parameters — finding an in-network clinician — and geography. Such barriers exist in urban settings, especially for racial and ethnic minorities.
Transportation is a critical social determinant of health (SDOH). The problem is that approximately 3.5 million patients forgo healthcare because they can’t access transportation to their providers. Even more alarming is that four percent of children in the U.S. mix medical appointments for this exact reason.
English is the predominant language in the U.S., of course, but one in five households in America speaks a different language at home. That can make it difficult for them to access a variety of services, not the least of which is healthcare. There’s a much higher risk of miscommunication.
When individuals don’t fully comprehend care instructions, they’re less likely to adhere to treatment recommendations and medication guidelines. Limited linguistics can even prohibit them from understanding the most basic health information, resulting in low health literacy.
There are two types of racial bias — implicit and explicit – and both can negatively affect a minority individual’s ability to access quality care. Implicit bias refers to unconscious prejudice, while its explicit counterpart consists of overt discrimination and racism. Both implicit and explicit racial bias among healthcare providers have been shown to harm health and further exacerbate health disparities among socioeconomically vulnerable populations.
Even if you haven’t experienced racial bias yourself, research has shown its prevalence in healthcare. At least one in 10 Black patients has reported discrimination during a healthcare encounter, and other racial and ethnic minorities are more likely to receive lower quality of care and encounter more obstacles to healthcare access compared to other groups.
Once a minority individual experiences racial bias during a healthcare encounter, he or she is less likely to return to that provider and instead rely on an emergency department. When attempting to access care in an inner city, many minority populations face inadequate and fewer available healthcare providers.
Practical Action Steps for Your Practice
Now that you know more of the obstacles patients encounter accessing care, what can you do? A lot, actually. Here are some easy-to-implement action steps:
- Offer convenient scheduling options.
- Use secure automated appointment reminders.
- Enable patients to use digital check-in to limit in-office wait times.
- Employ remote patient monitoring (RPM) for chronic care management.
- Provide the option of virtual care, especially telehealth.
- Expand office hours at least one day a week.
- Utilize the services of nurse practitioners and physician assistants when possible.
- Ensure staff is regularly trained on proper patient intake procedures.
- Establish or join a partnership with non-emergency medical transportation providers.
- Promote multi-language patient education materials.
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