Access To Health Services

This summary of the literature on Access to Health Services as a social determinant of health is a narrowly specified evaluation that is not meant to be exhaustive and might not attend to all measurements of the problem. Please note: The terminology utilized in each summary is constant with the respective references. For extra details on cross-cutting topics, please see the Access to Primary Care literature summary.
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Related Objectives (4 )


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Increase the proportion of teenagers who had a preventive healthcare go to in the previous year - AH-01
Increase the percentage of individuals with medical insurance - AHS-01
Increase the proportion of people with oral insurance - AHS-02
Increase the proportion of adults who get advised evidence-based preventive healthcare - AHS-08


Related Evidence-Based Resources (5 )


Here's a photo of the evidence-based resources connected to subjects covered in this literature summary. Browse all evidence-based resources.


Breast Cancer: Screening
Cervical Cancer: Screening
Colorectal Cancer: Screening
Improving Access to Oral Healthcare for Vulnerable and Underserved Populations
Oral Health in America: A Report of the Surgeon General


Healthy People 2030 organizes the social factors of health into 5 domains:


Economic Stability
Education Access and Quality
Healthcare Access and Quality
Neighborhood and Built Environment
Social and Community Context
Literature Summary


The National Academies of Sciences, Engineering, and Medicine (formerly called the Institute of Medicine) specify access to healthcare as the "timely usage of personal health services to accomplish the very best possible health outcomes."1 Many people deal with barriers that prevent or restrict access to needed healthcare services, which may increase the danger of poor health results and health disparities.2 This summary will talk about barriers to such as lack of medical insurance, poor access to transportation, and restricted healthcare resources, with a special concentrate on how these barriers effect under-resourced communities.


Unequal distribution of health care coverage adds to disparities in health.2 Out-of-pocket healthcare costs might lead people to delay or pass up required care (such as medical professional visits, oral care, and medications),3 and medical financial obligation is common among both insured and uninsured people.3,4 People with lower earnings are typically uninsured,5,6,7,8 and minority groups represent over half of the uninsured population.9


Lack of medical insurance coverage might adversely impact health.9,10 Uninsured grownups are less likely to get preventive services for persistent conditions such as diabetes, cancer, and heart disease.10,11 Similarly, kids without health insurance coverage are less most likely to receive proper treatment for conditions like asthma or crucial preventive services such as oral care, immunizations, and well-child sees that track developmental turning points.10


On the other hand, research studies reveal that having health insurance is associated with improved access to health services and much better health monitoring.12,13,14 One research study demonstrated that when formerly uninsured grownups ages 60 to 64 years became eligible for Medicare at age 65 years, their use of standard clinical services increased.13 Similarly, offering Medicaid coverage to formerly uninsured grownups considerably increased their chances of receiving a diabetes medical diagnosis and utilizing diabetic medications.15 Medicaid protection is also vital for enabling kids with special health needs or persistent diseases to access health services. The Children's Health Insurance Program (CHIP) offers sole protection for 41 percent of kids with unique health care requires.16 Many healthcare resources are more common in communities where homeowners are well-insured,10 however the type of insurance coverage people have might matter also. Medicaid patients, for example, experience access issues when living in areas where couple of physicians accept Medicaid due to its decreased reimbursement rate.14,17,18


Medical insurance alone can not remove every barrier to care. Limited accessibility of health care resources is another barrier that may decrease access to health services and increase the risk of poor health results.19,20 For instance, doctor shortages might suggest that patients experience longer wait times and delayed care.18


Inconvenient or unreliable transport can hinder constant access to health care, potentially contributing to negative health results.21 Research has actually revealed that people from racial/ethnic minority groups who had an increased threat for severe health problem from COVID-19 were more most likely to lack transport to health care services.22 Transportation barriers and property partition are likewise related to late-stage discussion of certain medical conditions (e.g., breast cancer).23,24,25


Expanding access to health services is an essential action towards minimizing health variations. Affordable health insurance is part of the service, however factors like economic, social, cultural, and geographic barriers to healthcare must also be considered,20 as need to new strategies to increase the efficiency of health care delivery.18,26,27 Further research is required to better understand barriers to healthcare, and this extra evidence will facilitate public health efforts to address access to health services as a social factor of health.


Citations


Institute of Medicine (U.S.) Committee on Monitoring Access to Personal Health Care Services. (1993 ). Access to healthcare in America (M. Millman, Ed.). National Academies Press.


Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Healthcare (2003 ). Unequal treatment: Confronting racial and ethnic disparities in health care (B. D. Smedley, A. Y. Stith, & A. R. Nelson, Eds.). National Academies Press.


Pryor, C., & Gurewich, D. (2004 ). Getting care however paying the rate: how medical debt leaves many in Massachusetts facing difficult choices. The Access Project.


Herman, P. M., Rissi, J. J., & Walsh, M. E. (2011 ). Medical insurance status, medical financial obligation, and their effect on access to care in Arizona. American Journal of Public Health, 101( 8 ), 1437-1443.


Hadley, J. (2003 ). Sicker and poorer - the effects of being uninsured: An evaluation of the research on the relationship in between health insurance coverage, medical care usage, health, work, and income. Medical-Car Research and Review, 60(2_suppl), 3S-75S.


Franks, P., Clancy, C. M., & Gold, M. R. (1993 ). Medical insurance and death: Evidence from a national mate. JAMA, 270( 6 ), 737-741.


Zhu, J., Brawarsky, P., Lipsitz, S., Huskamp, H., & Haas, J. S. (2010 ). Massachusetts health reform and disparities in coverage, gain access to and health status. Journal of General Internal Medicine, 25( 12 ), 1356-1362.


DeNavas-Walt, C. (2010 ). Income, poverty, and health insurance protection in the United States (2005 ). Diane Publishing.


Majerol, M., Newkirk, V., & Garfield, R. (2015 ). The uninsured: A primer. Kaiser Family Foundation Publication, 7451-10.


Institute of Medicine (U.S.) Committee on Health Insurance Status and Its Consequences. (2009 ). America's uninsured crisis: Consequences for health and health care. National Academies Press.


Ayanian, J. Z., Weissman, J. S., Schneider, E. C., Ginsburg, J. A., & Zaslavsky, A. M. (2000 ). Unmet health requirements of uninsured grownups in the United States. JAMA, 284( 16 ), 2061-2069.


Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., ... & Finkelstein, A. N. (2013 ). The Oregon experiment - effects of Medicaid on clinical outcomes. New England Journal of Medicine, 368( 18 ), 1713-1722.


McWilliams, J. M., Zaslavsky, A. M., Meara, E., & Ayanian, J. Z. (2003 ). Impact of Medicare coverage on standard scientific services for formerly uninsured adults. JAMA, 290( 6 ), 757-764.


Buchmueller, T. C., Grumbach, K., Kronick, R., & Kahn, J. G. (2005 ). Book review: The impact of medical insurance on medical care usage and ramifications for insurance expansion: A review of the literature. Medical Care Research and Review, 62( 1 ), 3-30.


Myerson, R., & Laiteerapong, N. (2016 ). The Affordable Care Act and diabetes diagnosis and care: Exploring the potential impacts. Current Diabetes Reports,16( 4 ), 1-8.


Musumeci, M. (2018 ). Medicaid's role for kids with special health care requirements. Journal of Law, Medicine & Ethics, 46( 4 ), 897-905.


Decker, S. L. (2012 ). In 2011 nearly one-third of doctors said they would not accept brand-new Medicaid patients, but increasing fees might help. Health Affairs, 31( 8 ), 1673-1679.


Bodenheimer, T., & Pham, H. H. (2010 ). Primary care: Current issues and proposed options. Health Affairs (Project Hope), 29( 5 ), 799-805. doi: 10.1377/ hlthaff.2010.0026.


National Association of Community Health Centers and the Robert Graham Center. (2007 ). Access rejected: A take a look at America's clinically disenfranchised. National Association of Community Health Centers, Incorporated.


Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015 ). Exposing some essential barriers to health care access in the rural USA. Public Health, 129( 6 ), 611-620. doi: 10.1016/ j.puhe.2015.04.001.


Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013 ). Traveling towards illness: Transportation barriers to health care gain access to. Journal of Community Health, 38( 5 ), 976-993. doi: 10.1007/ s10900-013-9681-1.


Clay, S. L., Woodson, M. J., Mazurek, K., & Antonio, B. (2021 ). Racial variations and COVID-19: Exploring the relationship between race/ethnicity, individual factors, health access/affordability, and conditions associated with an increased seriousness of COVID-19. Race and Social Problems, 1-13. doi: 10.1007/ s12552-021-09320-9.


Dai, D. (2010 ). Black property partition, variations in spatial access to healthcare centers, and late-stage breast cancer diagnosis in urban Detroit. Health & Place, 16( 5 ), 1038-1052. doi: 10.1016/ j.healthplace.2010.06.012.


Tarlov, E., Zenk, S. N., Campbell, R. T., Warnecke, R. B., & Block, R. (2009 ). Characteristics of mammography center locations and phase of breast cancer at medical diagnosis in Chicago. Journal of Urban Health: Bulletin of the New York City Academy of Medicine, 86( 2 ),196 -213. doi: 10.1007/ s11524-008-9320-9.


Wang, F., McLafferty, S., Escamilla, V., & Luo, L. (2008 ). Late-stage breast cancer diagnosis and health care access in Illinois. Professional Geographer, 60( 1 ), 54-69. doi: 10.1080/ 00330120701724087.
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Green, L. V., Savin, S., & Lu, Y. (2013 ). Medical care physician scarcities could be gotten rid of through use of teams, nonphysicians, and electronic communication. Health Affairs (Project Hope), 32( 1 ), 11-19. doi: 10.1377/ hlthaff.2012.1086.


Rieselbach, R. E., Crouse, B. J., & Frohna, J. G. (2010 ). Teaching medical care in neighborhood health centers: Addressing the labor force crisis for the underserved. Annals of Internal Medicine, 152( 2 ), 118-122.