While the quality of US health care and patient outcomes in general has improved over time, access to care—and thus positive patient outcomes—is not equal for all people. In general, one in 10 Americans does not have health insurancewhich is the result of a system breaking down under the weight of high costs and deepening complexity.
Diabetes rates are more than 30% higher among Native Americans and Latinos than among whites. Death rates attributable to heart disease, stroke, and prostate and breast cancer remain much higher in black populations.
If you live in a rural area and have a chronic disease (or multiple diseases), 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 affect access and equity in health care: socioeconomics, technology, gender, language barriers, and more. These factors are further complicated by the specific care needs of an individual.
Simply put, people without adequate health care insurance coverage or proximity to quality care do not have the same opportunities to access care, and their overall health may be negatively affected.
Making matters worse, the US health care system continues to be extremely difficult to navigate and fraught with administrative burdens. When it is easier and faster to access basic human needs than to visit a care provider, change is needed. In the search for meaningful solutions to these disparities, women’s health and technology investments are obvious places to start.
The case for greater access
Although the US health care system has its faults, we are a global leader in research, teaching, standards of care and clinical outcomes. According to the Global Healthcare Innovation Index, US health care system ranked sixth for innovation in 2021, but third for fiscal stability. This is what makes issues of access and equity frustrating. As care providers, collectively we know 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 get the care they need at the right time and in a way that supports their best personal outcome. This includes seeing a provider quickly and at a reasonable cost. Increasing access to preventive care would have an exponential benefit to individuals and to the health care system as a whole. Missed prevention opportunities alone cost US$55 billion annually. When we consider physical therapy as a first-line musculoskeletal intervention, research shows up to 26% cost savings over $1500/patient.
Access issues are not limited to seeing a doctor. Primary and preventive health services such as physical therapy are also at risk. As Medicare reimbursement rates for ancillary services like PT continue to decline, providers and patients are caught in the crossfire. Our goal is to help people maintain and return to their best physical health while leading a national practice that relies on margin growth to combat macro trends and invest for the future.
Access follows reimbursement and services covered by insurance companies. If providers are unable to provide services within business constraints, service shrinkage may result. Business models that rely on economies of scale may be forced to withdraw from 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 limiting access for the uninsured and underinsured. When faced with spending limited family dollars on food and shelter versus non-emergency medical care, care will be lost 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 purchasing decisions in the healthcare industry. And yet, women’s health is considered a distinct market and a subset of health care. Promoting women’s health is the single most impactful change we can make, as 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 could improve the health of an entire community or population. As advisors to many people on where and when to get care, we rarely acknowledge the strong impact and influence women have on the overall well-being of their family and acquaintances. Unfortunately, many women often put the care of others before their own.
In our roles as mothers, daughters, partners and more, we naturally care for others and should do the same for ourselves. Actually, 76% of American women spend up to 10 hours a day caring for partners, spouses and/or children, and one in five (19%) women spend more than 10 hours a day caring for others. If women are the influential guide for many to access health care, we must work harder to promote the health of all women. Our ability to play the role of facilitator of caring for others depends on it.
We can do much more
Beyond women’s health, we must identify workable solutions to other systemic inequities in the health care system. We must reverse the negative trend of declining reimbursement rates for preventive care and general access to services such as physical therapy.
Technology is another unlock for better healthcare access. These innovations include advances in how, when and where care is delivered. The Covid-19 pandemic showed us the power and potential of providing virtual care to improve access, via video telehealth or telephone. As we consider geographic limitations that place a premium on the availability of quality care, telehealth can play a major role in serving these populations.
Except this, telehealth can improve patient outcomes through advanced monitoring, cognitive capabilities, clinical decision support functions and the execution of life-saving and evidence-based critical care protocols, just to name a few innovations. The first step in the continued development and advancement of telehealth is for private and public payers to permanently cover these services and set reimbursement rates on par with in-person fee schedules.
We can do more to remove cost and complexity within the health care system, balanced with 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 whenever possible.
We owe it to our patients.
