HEALTHCARE IN THE UNITED STATES
ACCESS ISSUES IN HEALTH CARE
8.4 ACCESS TO HEALTHCARE
What does access to healthcare mean? Where is the U.S. regarding access to healthcare for the population? In 1993, the Institute of Medicine defined access to healthcare as “the timely use of personal health services to achieve the best possible health outcomes” (IOM, 1993, p. 31). The Office of Disease Prevention and Health Promotion (ODPHP, 2019a) uses this definition and lists three steps for obtaining access to needed healthcare services: (1) entrance into the system, usually through health insurance; (2) obtaining needed services within an accessible location; and (3) finding the right patient-provider relationship where communication, mutual trust, and respect are obtained. All three are essential in obtaining appropriate healthcare services.
8.4.1 Entrance into the System
Possessing health insurance may be considered as the gateway into the healthcare system. Without insurance coverage, most individuals are not willing to seek healthcare services unless faced with a life-threatening emergency—arguably, because of the expense. Hospital emergency departments are not allowed to turn anyone away because of the lack of health insurance. Conversely, physician offices can refuse to accept patients without insurance. Moreover, physician’s offices may also turn patients away if they have only Medicaid; some also refuse Medicare.
Public health departments provide free or reduced-priced services to community members. Low-income pregnant women are eligible for Medicaid, and children of low-income families are eligible for Medicaid or state-sponsored insurance for children. Medicare is available to individuals with disability, who are on dialysis, or those age greater than 65 years. Of importance to note is that individuals’ being eligible for insurance does not mean they are automatically enrolled or obtain insurance. However, without insurance, unless paying with cash, an individual will most likely have a difficult time accessing the healthcare system.
Pause and Reflect
Should physicians be able to turn patients away who have Medicaid? Should
state or federal government require physicians to accept Medicaid patients?
What sort of incentives might state or federal government provide to physicians
so they will begin to or increase acceptance of Medicaid patients?
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