While the quality of health care in the United States and patient outcomes have generally increased over time, access to care – and therefore to positive patient outcomes – is not equitable for all. Globally, one in 10 Americans has no health insurancewhich is the consequence of a system that is collapsing under the weight of high costs and increasing complexity.
Diabetes rates are more than 30% higher among Native Americans and Latinos than among whites. Death rates from heart disease, stroke, and prostate and breast cancer remain much higher in the black population.
If you live in a rural area and have a chronic illness (or multiple illnesses), provider options are more limited than in densely populated areas. This means that the availability of a specialist or even the ability to get an appointment can be a challenge.
There are many other variables that impact health care access and equity: socio-economics, technology, gender, language barriers, etc. These factors are further complicated by an individual’s specific care needs.
Simply put, people without adequate health insurance coverage or close to quality care do not have the same opportunities to access care and their overall health may be affected.
Worse still, the US healthcare system continues to be extremely difficult to navigate and fraught with administrative burdens. When accessing most basic human needs is easier and faster than seeing a care provider, change is needed. In the search for meaningful solutions to these inequalities, women’s health and technology investment are obvious starting points.
The case for better access
Although the American healthcare system has its flaws, we are a world leader in research, education, standards of care and clinical outcomes. According to the World Index of Healthcare Innovation, the The US healthcare system ranked sixth for innovation in 2021, but second to last for fiscal stability. This is what makes issues of access and equity frustrating. As healthcare providers, we collectively know that we can do more for more patients if our systems make it easier to deliver and access care.
In an ideal world, adequate access to health care would mean that everyone is able to receive the care they need in a timely manner and in a way that promotes their personal best outcome. This includes seeing a supplier quickly and at a reasonable cost. Increased access to preventive care would have exponential benefits for individuals and for the health system as a whole. Missed prevention opportunities alone cost the United States $55 billion every year. When considering physiotherapy as a first-line musculoskeletal intervention, research shows up to 26% cost savings over $1,500/patient.
Access issues are not limited to visiting a doctor. Frontline and preventive health services such as physiotherapy are also compromised. As Medicare reimbursement rates for ancillary services such as physical therapy continue to decline, providers and patients are caught in the dispute. Our goal is to help people maintain and regain their best physical health while running a national practice that relies on margin growth to fight macro trends and invest for the future.
Access follows reimbursement and benefits covered by insurance. If suppliers are unable to provide services within the boundaries of the business, a contraction of services may result. Business models based on economies of scale may be forced out of more rural and remote areas where demand for services is limited. This means even less access for people in rural communities, and the cycle continues.
Alternatively, if reduced reimbursement is passed on to patients in the form of higher premiums or out-of-pocket costs, fewer people will seek or be able to afford care, further restricting access for the uninsured and underprivileged. -insured. When faced with limited expenditure of household money for food and housing, c. non-emergency medical care, care will lose out every time, resulting in a less healthy population.
Make women’s health a priority
Women make up half of the world’s population but account for 80% of healthcare purchasing decisions. And even, Women’s health is considered a niche market and a subset of healthcare. Promoting women’s health is the most impactful change we can make, because women play a disproportionate role in how and when others access care.
When I was at Brigham and Women’s Hospital, I saw firsthand that improving the health of all women can improve the health of an entire community or population. As many advise where and when to seek care, we rarely recognize the strong influence and impact that women have on the overall well-being of their families and acquaintances. Unfortunately, many women put the care of others before their own.
In our roles as mothers, daughters, partners and more, we naturally care for others and need to do the same for ourselves. In fact, 76% of American women spend up to 10 hours a day caring for their partners, spouses and/or children, and one in five women (19%) spend more than 10 hours a day caring for others. If women are the influential guide for much access to health care, we must work harder to promote the health of all women. Our ability to play the role of facilitator of care for others depends on it.
We can do a lot more
Beyond women’s health, we need to identify workable solutions to other systemic inequities in the health system. We need to reverse the negative trend that declining reimbursement rates are having on preventive care and overall access to services such as physical therapy.
Technology is another unlock for better access to health care. These innovations encompass advances in how, when and where care is delivered. The Covid-19 pandemic has shown us the power and potential of virtual care delivery to improve access, via telehealth video or over the phone. As we think of geographic boundaries that value the availability of quality care, telehealth can play an outsized role in serving these populations.
In addition, telehealth can improve patient outcomes Through advanced monitoring, cognitive affordances, clinical decision support features, and the execution of vital, evidence-based critical care protocols, to name a few innovations. The first step in continuing the development and advancement of telehealth is for private and government payers to permanently cover these services and set reimbursement rates at par with in-person fee schedules.
We can do more to remove cost and complexity from the healthcare system, while improving access to care for those who struggle to get the care they need. As providers, we must continue to identify and remove barriers to care where possible.
We owe it to our patients.
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