Everyone should have the opportunity to achieve a healthy life and have comprehensive health care services available to them. To achieve this healthy life, people need to have access to the health care system and to a health care provider with whom they can develop a trusting relationship. However, existing barriers to attaining health care services often lead to disparities which in turn lead to differences in life expectancy, health status and a higher prevalence of certain chronic diseases (HealthyPeople.gov, 2012). Barriers
Barriers to health care can be defined as conditions that can restrict or prevent the access of necessary health care for vulnerable populations. In their study on public health insurance programs, DeVoe, et al. (2007) report that low-income families identified lack of insurance coverage, poor access to services, and unaffordable costs as the 3 major barriers to accessing health care. Even when families are able to obtain insurance, they still face obstacles such as unaffordable co-pays for office visits, deductibles, and prescriptions. Lack of insurance coverage and inability to pay for out-of-pocket expenses were also cited as the most common barriers by families in a study by Kullgren and McLaughlin (2010). When studying the elderly population, Horton (2010) found that socioeconomic barriers, including lack of insurance and low income, were the most frequent indicators of the inability to access adequate health care.
A second barrier that affects most vulnerable populations is a geographic barrier. Geographic barriers can affect people living in rural areas as well as inner cities. Kullgren and McLaughlin (2010) explain that these patients are affected by the lack of services and health care professionals. Inner cities as well as rural areas are affected by barriers such as problems with transportation, insufficient health care providers, and lack of quality health care and financial limitations. With the increasing immigrant population a third barrier affecting access to health care is a cultural barrier. Culture barriers can include values and beliefs, language and race and ethnicity. Health beliefs and behavior can become a barrier when patients decide not to seek medical treatment and instead turn to home remedies and healers when treating illnesses.
Approximately 10% of Americans speak a language other than English and can be classified ad being limited in their proficiency. For these patients language becomes a barrier and they are less likely to receive optimal medical treatment (Flores, 2006). Horton and Johnson (2010) stress the importance of communication in reducing disparities and increasing the trust of patients in the health care system. As reported by the American College of Physicians, evidence reveals that racial and ethnic minorities are more likely to receive inferior care when compared with non-minorities. This occurs even when minorities have access to insurance and adequate income (Racial and ethnic disparities in health care, 2010). Disparities
Barriers in health care can lead to disparities in meeting health needs and receiving appropriate care, including preventive services and the prevention of unnecessary hospitalizations (HealthyPeople.gov, 2012). In their 2008 annual report, the Agency for Healthcare Research and Quality lists several disparities’ in health care. They report that racial and ethnic minorities in the United States are more likely than non-minorities to receive lower quality of care (Alliance for Health Reform, 2008). This often leads to a higher death rate among minorities from preventable diseases. A 2005 report from the Centers for Disease Control and Prevention relates that more African-Americans died from heart disease, cancer and stroke than any other ethnicity. This report also states that African-Americans and Hispanics are less likely than Caucasians to receive influenza vaccines and other preventive forms of health care like wellness check-ups and colonoscopies.
Many of the patients affected by barriers to health care are also afflicted by certain diseases in disproportionate numbers. Lillie-Blanton, Maleque, and Miller (2008), report that adults with higher incomes have a better health status and live longer than the poor. They also cite a higher rate of diabetes and heart disease among the poor (Lillie-Blanton, Maleque, & Miller, 2008). Barriers to health care and the disparities they produce are a continuing problem in our health care system. As future health care providers we can begin to look for ways to improve the quality of care and reduce disparities in clinical practice.
Alliance for Health Reform. (2008). Retrieved from Racial and Ethnic Disparities in Health Care: www.allhealth.org/publications/pub_38.pdf (2010). Racial and ethnic disparities in health care. Philidelphia: American College of Physicians. HealthyPeople.gov. (2012). Retrieved from Access to Health Services: http://www.healthypeople.gov/2020 DeVoe, J. E., Baez, A., Angier, H., Krois, L., Edlund, C., & Carney, P. (2007). Insurance + acess does not equal health care: Typology of barriers to health care for low-income families. Annals of Family Medicine, 5(6), 511-518. Flores, G. (2006). Language barriers to health care in the United States. New England Journal of Medicine, 229-231. Horton, S. (2010). Improving access to health care for uninsured elderly patients. Public Health Nursing, 27, 362-370. Lillie-Blanton, M., Maleque, S., & Miller, W. (2008). Reducing racial, ethnic, and socioeconomic disparities in health care: Opportunities in national health reform. Journal of Law, Medicine and Ethics, 693-701.