What if your child had an accident or suddenly got very sick, but the nearest doctor was an hour’s drive away? Or you started experiencing symptoms of an illness but feared that it would cost too much to see a doctor. Or you worried that there wouldn’t be someone there who was bilingual or knew sign language?
These are just some of the barriers to healthcare access, a primary social driver of health, that exist for so many people in the U.S. Health equity means that everyone has the resources to be as healthy as possible; when social drivers create barriers to those resources — whether it’s to nutritious food, transportation, or healthcare access— it can create health disparities.
Geographic Access to Healthcare
Some barriers to healthcare are due to geography: For example, many rural residents can’t make a short drive to the local doctor’s office because there is no local doctor. These medical workforce shortages are found among general practitioners and specialists, and they’re projected to get worse. For example:
More than 56% of rural counties do not have a pediatrician, according to the Federal Office of Rural Health Policy.
- A 2022 report from the March of Dimes found that 2.2 million people of childbearing age lived in maternity care deserts (1,119 counties) with no access to a hospital offering obstetric care, a birth center, or an obstetric provider.
- In 2021, the U.S. had thousands of Health Professional Shortage Area designations, which are areas, populations, or facilities that have shortages of healthcare workers, including 7,447 for primary care and 5,930 for mental health professionals — affecting nearly 84 million people.
- By 2034, the U.S. is projected to have shortages of between 17,800 and 48,000 primary care physicians and 21,000 and 77,100 specialty physicians.
Experts say that these shortages are due to multiple factors, including a fixed pipeline for new doctors, a growing population, an aging population that has more health concerns, and burnout or retirements among healthcare professionals. Whatever the reasons, healthcare professional shortages create barriers to healthcare access for millions of people — and have real consequences.
Proximity and access to care make it easier and more convenient for people to get the primary and preventive care that will keep them healthier. Studies have shown that around the world, primary care leads to better health outcomes and fewer hospitalizations and emergency department visits. A pregnancy without prenatal care is five times more likely to end in a pregnancy-related death than one that does receive prenatal care.
Having doctors close by also improves health outcomes when it comes to medical treatment for acute conditions. If you have a medical emergency, the faster you can get to the hospital, the better your chances of surviving.
Financial Access to Healthcare
Another barrier to healthcare access can be cost, whether people are uninsured or are insured but have trouble paying the out-of-pocket costs of care. When people cannot afford healthcare, they’re less likely to have a regular primary care doctor and more likely to skip preventive care — and that can contribute to chronic health problems.
“Someone might be in proximity to a medical center and they may have insurance, but they may still not be able to access care because it's not affordable,” said Elevance Health Chief Health Officer Dr. Shantanu Agrawal. “Maybe they're underinsured — there are many dynamics impacting access.”
The Kaiser Family Foundation found that about 40% of U.S. adults say they have delayed or skipped medical care due to cost. Even those with insurance worry about financial barriers to healthcare: A third of insured adults worried about paying for their monthly health insurance premium and 44% were concerned about whether they could afford their deductible.
The good news is that since 2010, there has been a significant drop in the number of people who lack health insurance, falling from 46.5 million to fewer than 26.7 million in 2016, after the passage of the Affordable Care Act. That number is slowly rising again, however, and there were 28.9 million uninsured people in 2019.
The reality is that people of color are more likely to be uninsured than their white counterparts. People of color make up 43% of the U.S. population under 65 but they account for more than half (59%) of the uninsured population. A federal report also found that there were broad health disparities in the quality of care for people of color compared to white individuals.
“Access is not just about geography or ensuring that people have the ability to meet their care team virtually,” Agrawal said. “It’s also about making sure that care is affordable so that people can get those services that can optimize their health — and in turn create a healthier society.”