How Cost Influences Access to Healthcare Services

Access to healthcare is a fundamental right, yet for many, cost remains a significant barrier. The affordability of medical services and prescription drugs has a profound influence on your ability to receive necessary care. Healthcare costs continue to rise, impacting individuals and families across all socioeconomic levels. This growing concern has led to increased focus on healthcare affordability and its effect on overall public health.

You may face challenges in accessing healthcare due to financial constraints, insurance limitations, or the high cost of prescription medications. These barriers can lead to delayed or foregone care, potentially resulting in more severe health issues down the line. To address this problem, various strategies are being explored to improve access to care and reduce the financial burden on patients. From policy changes to innovative programs, efforts are underway to make healthcare more accessible and affordable for all.

Financial Barriers to Healthcare Access

Health Insurance Coverage

Despite over 90% of the U.S. population having some form of health insurance, access to healthcare remains a significant challenge for many. Uninsured adults are less likely to receive preventive services and timely care for chronic conditions like diabetes, cancer, and cardiovascular disease. Even when you have insurance, inadequate coverage can lead to delayed or forgone care.

Inside Rx may be able to help you save up to 80% on your prescription and over-the-counter medications at 60,000 pharmacies nationwide, whether you're uninsured, underinsured, in a high-deductible plan, or paying out of pocket.

Out-of-Pocket Costs

High deductibles and other forms of cost-sharing can result in unaffordable medical bills, even for insured individuals. About half of adults say they would be unable to pay an unexpected $500 medical bill without borrowing money. This financial strain has led many to cut spending on essential items like food and clothing or to deplete their savings to pay medical bills.

Medical Debt

Medical debt is a widespread issue in the United States, affecting both insured and uninsured adults. Approximately 20 million people (nearly 1 in 12 adults) owe medical debt, with the total amount owed reaching at least $220 billion. Of those with medical debt, about 14 million people (6% of adults) owe over $1,000, and around 3 million (1% of adults) owe more than $10,000.

Certain groups have a higher likelihood of incurring medical debt:

1. People with disabilities or in worse health (13% vs. 6% without disabilities)
2. Lower-income individuals (1 in 10 adults with incomes below 400% of the federal poverty level)
3. Uninsured or partially insured individuals

Medical debt has far-reaching consequences. One in seven adults with healthcare debt report being denied care by a provider due to unpaid bills. Additionally, those with medical debt are more than twice as likely to postpone or skip needed healthcare due to cost concerns.

Disparities in Healthcare Access

Income-Related Disparities

Access to healthcare varies significantly based on income levels. People in poor households have worse access to care than those in high-income households for 79% of access measures. This disparity extends to low-income and middle-income households as well, with 71% and 50% of access measures showing worse outcomes, respectively. Nearly a quarter of the U.S. population is covered by a health plan all year that doesn't ensure affordable access to care.

Racial and Ethnic Disparities

Racial and ethnic minorities often face greater challenges in accessing healthcare. Hispanic people had worse access to care than non-Hispanic White people for 79% of access measures. Black people experienced worse access for 53% of measures, while American Indian and Alaska Native (AI/AN) people faced barriers in 50% of measures. Asian people had worse access for 29% of measures but better access in 14%.

These disparities manifest in various health outcomes. For instance, African American women had the highest percentage of preterm singleton births at 11.1%, while Asian or Pacific Islander women had the lowest at 6.8%. Native Americans and Alaska Natives have an infant mortality rate 60% higher than their white counterparts.

Geographic Disparities

Where you live can significantly influence your access to healthcare. People in large central metro areas had worse access to care than those in large fringe metro areas for 71% of access measures. Those in micropolitan areas faced barriers in 50% of measures, while people in small metro and noncore areas experienced challenges in 36% and 33% of measures, respectively.

Rural residents are, on average, poorer, older, and less likely to have insurance if under 65 compared to urban dwellers. They also report more chronic conditions and describe themselves in poorer health. These geographic disparities often intersect with racial and income-related disparities, compounding the challenges in accessing healthcare.

Consequences of Limited Healthcare Access

Delayed or Forgone Care

Limited access to healthcare often results in delayed or forgone care. According to the 2019 National Health Interview Survey, 8.5% of people delayed or did not receive medical care, 14.7% postponed dental care, and 5.6% skipped prescription medication due to cost. This delay in care has significant consequences. For instance, approximately one-third of nonelderly adults who reported delaying care experienced worsening health conditions or limited ability to work or perform daily activities.

Poor Health Outcomes

Limited healthcare access has a profound impact on health outcomes. Poverty is directly correlated with poor health outcomes, with higher disease burden observed in low-income populations. During the COVID-19 pandemic, poverty became a stronger predictor of infection risk, negative health outcomes, and mortality. Lack of health insurance can lead to financial strain when making medication or treatment decisions, potentially worsening chronic conditions. For example, a 2021 study found that kidney failure diagnoses were more pervasive in the absence of insurance coverage for dialysis treatment.

Increased Emergency Department Use

Limited access to regular healthcare often results in increased emergency department (ED) use. For those reporting one or more access barriers, one in three adults visited an ED at least once during the preceding year, compared to one in five for those without access barriers. Factors such as difficulty getting appointments, long wait times, and lack of transportation were independently associated with higher ED use. This increased reliance on emergency services can lead to overcrowded EDs and higher healthcare costs overall.

Strategies to Improve Healthcare Access

Expanding Insurance Coverage

To improve access to healthcare, expanding insurance coverage is crucial. States may pursue various strategies to control spending growth and enhance access, ranging from promoting competition to imposing spending targets and promoting payment reform. One effective approach is to reduce the employer affordability threshold, allowing more people to enroll in marketplace plans if their employer-sponsored coverage exceeds 8.5% of their income.

Reducing Out-of-Pocket Costs

Reducing out-of-pocket costs is essential to improve healthcare access. Implementing a $10 billion reinsurance fund can help make nongroup insurance more affordable for those ineligible for subsidies. Enhancing and funding marketplace cost-sharing subsidies, known as cost-sharing reductions (CSRs), can significantly reduce expenses for low-income individuals. Removing user fees while ensuring sufficient quality of health services has proven effective in providing financial protection and increasing the use of health services.

Addressing Non-Financial Barriers

Non-financial barriers also play a significant role in healthcare access. These include poor quality of services, long waiting times, perceived provider behavior, lack of knowledge, cultural or language barriers, and distance to health facilities. To address these issues, it's crucial to improve the quality of health services, reduce waiting times, and enhance provider-patient communication. Additionally, increasing awareness about the need for health services and addressing cultural and linguistic barriers can help improve access to healthcare.

Conclusion

The cost of healthcare has a significant influence on access to essential medical services, creating barriers for many individuals and families. Financial constraints, inadequate insurance coverage, and high out-of-pocket expenses often lead to delayed or forgone care, potentially resulting in worse health outcomes. To address these challenges, various strategies are being explored, including expanding insurance coverage, reducing out-of-pocket costs, and tackling non-financial barriers like long wait times and cultural obstacles.

Improving access to affordable healthcare is crucial to ensure better public health outcomes and reduce disparities among different socioeconomic groups. By implementing comprehensive solutions that address both financial and non-financial barriers, we can work towards a healthcare system that is more accessible and equitable for all. It's worth noting that Inside Rx may be able to help you save up to 80% on your prescription and over-the-counter medications at 60,000 pharmacies nationwide, whether you're uninsured, underinsured, in a high-deductible plan, or paying out of pocket.