3 Access to care issues
“US Healthcare system Chapter 8” by Deanna L. Howe, Andrea L. Dozier, Sheree O. Dickenson, University of North Georgia Press is licensed under CC BY-SA 4.0
3.1 LEARNING OBJECTIVES
By the end of this chapter, the student will be able to:
- Define access to healthcare
- Discuss barriers to healthcare
- Define health literacy
- Explain initiatives to increase access to healthcare
- Describe possible improvements in the healthcare system
3.2 KEY TERMS
- access
- civilian
- equitable care
- health-seeking behaviors
- high deductible
- health disparities
- health literacy
- usual place of healthcare
3.3 INTRODUCTION
Having good health contributes to quality of life. Knowing that healthcare resources are available and easily accessible without depleting most of one’s resources in times of need provides a sense of security. In this chapter, we explore the degree to which persons in the U.S. are without access to healthcare, barriers to healthcare access, consequences of inadequate access to healthcare, and possible measures to improve healthcare in the immediate future.
3.4 ACCESS TO HEALTHCARE
What does access to healthcare mean? Where is the U.S. regarding access to healthcare for the population? In 1993, the Institute of Medicine defined access to healthcare as “the timely use of personal health services to achieve the best possible health outcomes” (IOM, 1993, p. 31). The Office of Disease Prevention and Health Promotion (ODPHP, 2019a) uses this definition and lists three steps for obtaining access to needed healthcare services: (1) entrance into the system, usually through health insurance; (2) obtaining needed services within an accessible location; and (3) finding the right patient-provider relationship where communication, mutual trust, and respect are obtained. All three are essential in obtaining appropriate healthcare services.
Entrance into the System
Possessing health insurance may be considered as the gateway into the healthcare system. Without insurance coverage, most individuals are not willing to seek healthcare services unless faced with a life-threatening emergency—arguably, because of the expense. Hospital emergency departments are not allowed to turn anyone away because of the lack of health insurance. Conversely, physician offices can refuse to accept patients without insurance. Moreover, physician’s offices may turn patients away if they have only Medicaid; some also refuse Medicare.
Public health departments provide free or reduced-priced services to community members. Low-income pregnant women are eligible for Medicaid, and children of low-income families are eligible for Medicaid or state-sponsored insurance for children. Medicare is available to individuals with disability, who are on dialysis, or those age greater than 65 years. Of importance to note is that individuals’ being eligible for insurance does not mean they are automatically enrolled or obtain insurance. However, without insurance, unless pay