Access to Care

December 15, 2014 - Having easy access to health care has been shown to improve the health of an individual and consequently, have a beneficial effect on society in general. Much has been discussed over the past few years as the Affordable Care Act has matured and improved access in over half of the states in the Union.

However, as a nation we still rank last of eleven high-income countries on measures of financial access to care, as well as availability of care on nights and weekends, according to a 2013 Commonwealth Fund survey of adults. This report was reviewed in a recent New England Journal of Medicine (NEJM) and, states that, “Uninsured people in the United States are particularly likely to report encountering barriers to care.” The other ten countries are Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.

Lower income adults in America, without insurance, are more likely not to visit a physician because of cost. They also do not fill prescriptions, skip drug doses, do not get recommended testing, and neglect follow-up care. At least 30% of the lower income population report financial barriers to care. In the other ten counties in the survey this financial barrier was about 10%.

Even though the popular notion is that other countries ration care, in actuality, obtaining timely primary care in America is more difficult than in other countries. Lower income adults in America reported waited six or more days for an appointment; it was even more difficult for evenings, weekends and holidays.

Elective procedures in other nations may be delayed for months, but then again, most elective surgery can be anticipated months ahead of time. Think of the need for total hip or knee replacement surgery due to the “wear and tear” type of arthritis—the most common reason for this type of surgery. This degenerative condition evolved over years so waiting another few months is not unreasonable. Urgent care or surgery can usually be accommodated easily, as not-for-profit health-care organizations in America are mission drive, namely caring for patients—with citizen boards directing the leadership team to: 1. demonstrate quality; 2. care for everyone; 3. make a modest profit.

For-profit health-care systems are responsible to their stockholders every quarter, which substantially changes their priorities in order to place profit or return to shareholders first. Not-for-profit systems, like NCH, have decades-long viewpoints. This enables us to make long-term commitments in the community, as we have done with the Mayo Clinic Affiliation and, more recently, the Blue Zones Project.

The Blue Zones Project is a community-wide, well-being improvement initiative designed to make healthy choices easier. It encourages sustainable changes in our built environment and social networks, often suggesting policy changes involving worksites, schools, restaurants, grocery stores and neighborhoods. By helping people live longer and better through behavior change, communities can lower healthcare costs, improve productivity, and enjoy a higher quality of life as they live, work, learn, worship and grow.

Interestingly, higher-income adults in America are not more likely than higher-income adults in other countries to report having difficulty getting an appointment or care on nights and weekends. However, higher-income Americans share with lower-income Americans the propensity to avoid care due to out-of- pocket costs for the following services: visiting a physician, filling a prescription, taking all the recommended doses, getting recommended diagnostic tests, etc. Almost 20% of Americans with above-average income report not visiting a doctor for a medical problem because of cost; this compares to 5% of their counterparts in other countries, according to this same NEJM article.

As we can see, on average everyone in America—both rich and poor—are avoiding care due to cost. We can do better as a nation. There is already plenty of money being spent on health care; nearly 19% of the Gross Domestic Product is consumed by health care, which continues to grow. We need to reduce spending and cost in a responsible manner by empowering medical homes and mid-level providers, and changing the way we pay for services from volume to value.

We are in a digital age with more and better technology than ever. Many other industries have already changed and become more efficient: banking, finance, communications, military, etc. We can and must change to have better access for care for everyone—without bankrupting the system.

America is adaptable and we have led the world in the past. We can do it again … as we serve the world.

Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.