The advent of the Affordable Care Act was meant, in part, to help to increase the access that all Americans have to healthcare providers. However, while this has meant that a larger number of families now have health insurance, there is still a long ways to go before equitable access to healthcare is achieved.For medical students who will be coming into practice in the near future, an understanding of this issue and why it is important is a critical beginning to producing new physicians that are aware of the problem and are willing to be both proactive and creative when it comes to finding solutions to it. This article covers health care disparity and why it is important, as well as practical solutions to help close the gap of access to medical care in America.
The CDC Report: Just How Bad is It?
Because healthcare can be such a highly politicized issue, it can be difficult to find nonpartisan information on particularly sensitive issues like healthcare equality (or inequality). One good source to look at, however, is the Center for Disease Control (CDC) Health Disparities and Inequalities Report: an annual analysis which looks at the state of health care inequalities and researches the racial, ethnic, geographical, socioeconomic and other factors which act as barriers to healthcare, factoring in things like risk for disease and environmental and social determinants.
The latest report indicates two important things:
1. Communities composed mostly of minorities continue to suffer from lower socioeconomic status, greater barriers to healthcare access and greater disease burdens than non-minority communities in the same state.
2. Almost none of the disparities in access to care are improving.
This problem is not one just of ethics but of economics as well: it is estimated that being able to close these gaps in access to healthcare can reduce direct medical costs by approximately $229.4 billion dollars.
Why is This Important?
Equitable access to healthcare is an important issue that should concern not only medical students about to begin their careers, but also healthcare providers in general and society at large. Studies have shown that access to healthcare services can promote a trusting, long-term relationship between a physician and patient and is associated with better overall physical and mental health status. It is also associated with other positive health parameters such as prevention of disease and disability, early detection of (and treatment for) disease, increased life expectancy and quality of life and a decrease in preventable deaths, use of emergency departments and hospitalizations.
Conversely, a lack of access to healthcare is associated with unmet medical needs, delays in receiving necessary care, an increase in usage of the ER and preventable hospitalizations.
In short, this issue can affect the entire healthcare system, from hospitals and clinics to home-based services like home health and hospice. It is also something which can impact clinical practice from general/family medicine to specialists.
What to Do?
Since equitable access to healthcare is not a simple issue, it logically follows that there will not be a simple solution to solving it, either. It is likely, however, that access can be improved through some combination of the following innovations:
Supporting and Encouraging Primary Care/Family Medicine Physicians
When it comes to the question of healthcare access, the importance of family care and general practice physicians cannot be overstated. Primary care physicians can provide stable, long-term continuity of care for their patients and build up a therapeutic relationship of trust that is difficult or impossible to build in any other context. However, fewer doctors are opting to go into general practice. Medical schools should therefore be encouraging more of their students to become PCPs – and also making it materially easier for them to do so. Debt forgiveness programs for those who work in primary care and other incentives could help make general practice look more attractive for physicians-to-be.
Expanding the Role of Physician Assistants, Nurse Practitioners and other Healthcare Professionals
Even while efforts should be made to boost the number of primary care physicians in the United States, a focus should also be put on expanding the role that physician’s assistants, nurse practitioners, pharmacists and other skilled healthcare staff can play in meeting the needs of patients. Expanding scope of practice laws and allowing these professionals to practice to the fullest extent of their training (though not, of course, beyond that), can also ease the patient burden and make it easier for patients to see a qualified practitioner.
Increasing Acceptance of Medicare and Medicaid
Another important strategy for increasing access to medical care is to increase acceptance rates of Medicare and Medicaid among healthcare providers. Studies show that Medicaid acceptance rates are actually down from 55.4 in 2005 to 45.7 in 2014. Increasing acceptance rates of Medicare alone could improve the health of low income seniors – and with Baby Boomers coming into retirement and the largest segment of the population in the +85 category, the impact of this could be huge. Government incentive programs to make acceptance of these patients more attractive to physicians would help with this particular patient population.
Developing Systems of Coordinating Care
Access to medical care can be improved if that care is coordinated and if healthcare providers – including general practitioners and specialists, nurses, pharmacists, physical and other therapists and medical social workers – can work together as a team and provide patient care that is truly coordinated and accessible to all members of the team. This increase in coordination can help make healthcare more efficient and is linked to better patient outcomes. In Oregon, for instance, Coordinated Care Organizations have resulted in a 13% drop in emergency room visits, a 32% drop in hospitalizations and a 16% drop in primary care visits. Another version of coordinated care is called the Patient-Centered Medical Home (PCMH) which takes a holistic, team-based approach to patient care and which is sweeping across the country: there are now 6,000 medical practices caring for 30,000 patients in 49 different states that have been designated at PCMH’s.
Support Preventative Medicine Initiatives
Countless studies have shown that good preventative health care is not only an extremely cost-effective way to practice medicine, it is associated with better patient health status and quality of life. Good preventative medicine – including vaccinations, instruction on weight loss and other healthy lifestyle choices and cancer screenings like mammograms and colonoscopies can ease the financial strain on the American healthcare system by avoiding the onset of the disease or detecting it early when more treatment options are possible. Making preventative medicine accessible is therefore extra important and can come in the form of community screenings for blood pressure, blood sugar and weight, vaccinations clinics and community programs to increase awareness of health lifestyle choices.
There is a great potential in modern medical technology to help bring medical care to those who most need it. Perhaps one of the most useful aspects of the Affordable Care Act was the importance it placed upon electronic records that are easily accessible by physicians and other members of the healthcare team as well as by patients and their families. These records can help with continuity of care among team members and Telehealth and the use of technology for patients to “virtually” visit with their providers is also helping bring high quality health care to inner city urban and isolated, rural poor alike as well as for patients who are disable, bed-bound or otherwise immobile – in short, vulnerable patient populations.Reducing Administrative Burden on MDs
Another problem with the healthcare system is the amount of paperwork and other administrative tasks that keeps doctors away from patients and at the desk. Reducing the amount of paperwork and/or making it easier for doctors to delegate the paperwork to other members of the healthcare team will increase the time that doctors can spend actually practicing medicine. It could also help to reduce the risk of burnout, a common problem especially prevalent in primary care physicians.
Working Smarter, Not Harder
This is not often considered when discussions of healthcare access come up, but the intelligent and savvy administration of a hospital or clinic, for example, can also help to increase patient access to healthcare. A well-run clinic which is sensitive to the supply-and-demand nature of patients and providers, which efficiently does the work it needs to do daily to meet this demand and which works out contingency plans can maximize the flexibility of a clinic even on unexpectedly busy days. Also, finding ways to reduce the need for patient visits – such as communicating with patients by email – can also help.
While no one of these solutions is going to solve America’s healthcare woes, some combination of them, practiced consistently throughout the states, could very well help to expand access that all Americans should have to consistent, quality health care providers. This in turn, could help to ease the burden placed on our medical system and make for a country which, as a whole, has better health parameters and overall quality of life.
References
Access to Health Services. Healthy People.Gov Initiative. 2015.
www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
Meyer, P. et. al. Health Disparities and Inequalities Reports. Center for Disease Control.
2013. www.cdc.gov/mmwr/pdf/other/366203.pdf
Primary Care Access. Innovation for Healthcare Improvement. 2015
www.ihi.org/topics/PrimaryCareAccess/Page/default.aspx
Sederston, J. 7 Ways to Improve Access. Managed Health Executive. 2014
http://managedhealthcareexecutive.m…ontent/tags/access-care/7-ways-improve-access
Brian Wu, MD, Ph.D., MNM, graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology, and graduated from the Keck School of Medicine (University of Southern California) with an MD with a focus on holistic care and treatment. He currently holds a Ph.D. in integrative biology and disease for his research in exercise physiology and rehabilitation.