Access to Care

Access to affordable, quality health care is important to physical, social, and mental health. Health insurance helps individuals and families access needed primary care, specialists, and emergency care, but does not ensure access on its own—it is also necessary for providers to offer affordable care, be available to treat patients, and be in relatively close proximity to patients.

Why Is Access to Care Important to Health?

Together, health insurance, local care options, and a usual source of care help to ensure access to health care. Having access to care allows individuals to enter the health care system, find care easily and locally, pay for care, and get their health needs met. 

In 2016, 28 million Americans younger than age 65 were uninsured, nearly a 16 million decrease since 2013.[1] Health insurance reforms, such as the Affordable Care Act (ACA), helped to extend coverage to many previously uninsured individuals. By the end of the 2015 enrollment period, 11.7 million Americans were reported as having chosen an insurance plan through the ACA Marketplace.[2] Medicaid expansion states saw insurance rates that declined 52.5% from 2013 to 2015, while states that did not adopt expansion saw only a 30.6% decline in uninsured.[2]

The uninsured are much less likely to have primary care providers than the insured; they also receive less preventive care, dental care, chronic disease management, and behavioral health counseling. Those without insurance are often diagnosed at later, less treatable disease stages than those with insurance and, overall, have worse health outcomes, lower quality of life, and higher mortality rates.[3] However, insurance by itself does not remove all barriers in access to care. Language barriers, distance to care, and racial disparities in treatment present further barriers to care.[4-6]

Nationally, many counties lack sufficient providers to meet patient needs; as of 2017, there were about 6,900 primary care, 5,000 mental health, and 5,700 dental federally designated “Health Professional Shortage Areas” in the US.[7] Having a usual primary care provider is associated with a higher likelihood of appropriate care, and a usual source of care is associated with better health outcomes. In 2010, 86% of Americans had a usual source of care, but those with low incomes were less likely to than those with higher incomes, and the uninsured were twice as likely as the insured to lack a usual care source.[3] Additionally, neighborhoods with low health insurance rates often have fewer providers, hospital beds and emergency resources than areas with higher rates. Even the insured have more difficulty getting care in these areas.[8]

Cost can be a barrier to care even for those who have insurance. In 2009, 17% of people younger than 65 had premium and out of pocket costs totaling more than 10% of their family income. From 2010 to 2012, over half of Americans with chronic illness reported that cost was a barrier in access to care.[9] Those with private, non-group insurance were three times as likely as those with employer-sponsored insurance to face such costs.[3]

Adopting and implementing strategies that reduce barriers to care and better match providers to community needs can increase access to care, improving health and well-being.

References

[1] Kaiser Commission on Medicaid and the Uninsured. Key facts about the uninsured population. Henry J. Kaiser Family Foundation; November 2017. Fact sheet.

[2] Serakos M, Wolfe B. The ACA: Impacts on Health, Access, and Employment. Forum Health Econ Policy. 2016;19(2):201–259.

[3] Clancy C, Munier W, Brady J, et al. 2012 National healthcare quality report. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2013.

[4] Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc Sci Med. 2018 Feb;199:219-229.

[5] Buzza, C., Ono, S.S., Turvey, C. et al. J GEN INTERN MED (2011) 26(Suppl 2): 648. https://doi.org/10.1007/s11606-011-1762-1

[6] Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR. The "Battle" of Managing Language Barriers in Health Care. Clin Pediatr (Phila). 2016 Dec;55(14):1318-1327.

[7] US Department of Health and Human Services. Health Resources and Services Administration (HRSA). Shortage Areas. Last reviewed September 30, 2018. Accessed March 14, 2019. 

[8] Robert Wood Johnson Foundation (RWJF). What is the link between having health insurance and getting adequate health care? Princeton: Robert Wood Johnson Foundation (RWJF); August 2011. Health policy snapshot.

See how this component fits into our model
Loading interactive model…

Our Rankings show how healthy a community is as well as indicators for future health. This provides a starting point for action on improving health for all. Dig deeper into the measures below to learn more about our approaches to measuring health.

When it comes to developing and implementing solutions to problems that affect communities, evidence matters. The strategies below give some ideas of ways communities can harness evidence to make a difference locally. You can learn more about these and other strategies in What Works for Health, which summarizes and rates evidence for policies, programs, and systems changes.

Increase support for non-profit health care organizations and deliver comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay; often called community health centers (CHCs)
Provide continuous, comprehensive, whole person primary care that uses a coordinated team of medical providers across the health care system
Provide sealants, fluoride treatment, screening, and other preventive dental care on school grounds via partnerships with dental professionals
Provide health care services on school premises to attending elementary, middle, and high school students; services provided by teams of nurses, nurse practitioners, and physicians
Deliver consultative, diagnostic, and treatment services remotely for patients who live in areas with limited access to care or would benefit from frequent monitoring; also called telehealth

The County Health Rankings provide a snapshot of a community’s health and a starting point for investigating and discussing ways to improve health. Select a state below to see what’s happening locally.