America’s health care system is a study in inequality and, often, unnecessary suffering. The richest Americans live 12 years longer than their socioeconomically disadvantaged counterparts, and the gap is growing far more quickly in the United States than in comparably wealthy European nations.
People of color, those who live in remote areas and the socioeconomically disadvantaged face tremendous barriers to obtaining the medical treatments they need to lead active, meaningful lives. Here are five ways we need to improve accessibility for vulnerable populations.
1. Address access to rural communities
Imagine needing a life-saving procedure but having no way to access the medical center. This scenario might sound unimaginable if you live in a well-populated area, but it’s business as usual for folks in rural areas for several reasons.
Even getting a diagnosis can take years in some cases, which becomes more problematic if people have to travel long distances. Hourly workers struggling to get by often simply can’t take the necessary time away from work to attend appointments, lest they fall short on rent. Some may lack vehicles or have health conditions that prohibit driving long distances.
Telemedicine promises to expand access to people in rural areas who may otherwise need to take a full day or more off work to attend appointments. Recent studies on COPD, asthma and cystic fibrosis patients show that this approach can save considerable money while improving the overall quality of care.
2. Improve transportation in urban areas
Even people who live in densely populated urban areas can struggle with health care accessibility if they encounter buildings they can’t enter or have to hassle with complicated, even nonexistent, public transportation systems. Some insurance companies have included rides to medical appointments as a covered benefit, but these programs don’t help those without coverage.
The Americans With Disabilities Act provides guidelines to public and private transportation providers outlining their duties and responsibilities toward those with disabilities. However, there is still room for improvement. For example, expanding complementary paratransit services and teaching drivers how to manage those with disabilities requiring assistance beyond curb-to-door can improve accessibility for people who need mobility aids to navigate.
3. Increase availability of specialist appointments
Unique barriers stand between patients and the specialist appointments they often need to confirm their diagnoses and get the treatment necessary for recovery. For example, the for-profit U.S. system typically requires these individuals to visit a primary care doctor first, a professional to whom many people already lack meaningful access.
Then, they often have to come up with a higher copay for each office visit — and it can take one such trip to get approval for a procedure for an MRI. After that, they must make yet another trip for the examination.
Finally, specialists often congregate in urban areas. Here, telemedicine offers immediate relief. Patients who need to seek specialty care can report to a nearby medical center. A nurse monitors their vitals while meeting their assigned professional via computer screen, receiving needed prescriptions and satisfying insurance requirements for office visits before approving certain procedures.
4. Include dental, visual and hearing coverage
Your teeth are not luxury bones, and what happens in your mouth significantly impacts your overall health. For example, researchers have found an association between oral bacteria and Alzheimer’s disease. They also suspect the same germs responsible for gingivitis increase your risk of cardiovascular disease.
However, many Americans skip their annual dental cleaning because they can’t afford the expense. Even those with oral care coverage often find it doesn’t pay for certain procedures like crowns, and they prefer the ostrich approach to knowing about a problem they can’t afford to fix. Unfortunately, they can unwittingly increase their chances of tooth decay and loss and develop other, more serious health problems.
Likewise, you need to see clearly to avoid automobile accidents and even navigate city streets without getting lost and putting yourself in danger. It’s less problematic to seek glasses or contacts overseas and even obtain an online vision exam, but it doesn’t substitute for care from a professional ophthalmologist.
Vision care deserves inclusion in any comprehensive insurance package. Unfortunately, Medicare doesn’t include this coverage minus a supplement, meaning that many seniors on fixed incomes must choose between clear eyesight and food on the table.
Finally, hearing loss can profoundly impact overall life quality and even expectancy. Many people choose to isolate themselves rather than ask family and friends to repeat themselves, but such loneliness can kill. In the short term, adding hearing aid coverage to Medicare will tremendously improve the health of many older adults.
5. Expand coverage to everyone
Not every American is eligible for Medicare. No national health program covers everyone regardless of age or socioeconomic status. As a result, over 30 million Americans go without coverage daily, preventing them from seeking care even when needed. Additionally, medical bills account for more bankruptcies than anything else.
How the U.S. continues to justify this health care inequality boggles the mind, but it’s a problem politicians must stop ignoring if the country is to remain competitive globally. Poor health costs businesses $575 billion every year, and even the most successful companies often struggle to keep up with policy expenses. Those who can’t afford full coverage often leave their staff paying much of the tab, keeping them underinsured. They can’t afford to use their policy after paying the hefty premiums, thanks to copays and deductibles.
All insurance coverage — whether for health or automobiles — works by spreading risks across the greatest possible number of people. The Congressional Budget Office estimates that the country could save billions each year by switching to a single-payer system covering everyone. The ongoing failure to address this crisis contributes to the health care disparity in this nation. Worse, it causes many economically disadvantaged people to die simply because they couldn’t afford needed care.
Making health care accessible for all
The United States is a study in health care inequality. Addressing the vast disparities is necessary to ensure ongoing competitiveness in a global economy.
The five steps above could significantly improve health care access for vulnerable populations. Everyone should be able to see a doctor when they get sick, and a nation as wealthy as the U.S. should cooperate to make such care a reality.