American adults delay or forgo getting medical care for a wide variety of reasons, the most common being financial. However, there are a number of other barriers created by the interconnection of oppression, stigma, and socioeconomic status that are important to consider.

Often, we become accustomed to unsettling statistics that do not reveal the true reasons for inequities. Individuals and inherent physiology are not to blame. It is largely because of barriers to access due to oppression, stigma, and socioeconomic status that lead to health inequities.  

These barriers can be grouped into four main categories:

1. Cost
2. Discrimination and bias
3. Access
4. Health literacy and language barriers

Understanding the main barriers to health care.

While access to health care is a major determinant of a person’s overall wellness and longevity, up to 80% of health outcomes are affected by social, economic, and environmental factors. This means that it’s necessary to factor in the system-wide inequities that create barriers to accessing quality health care.

While our list isn’t exhaustive, read below to start learning about barriers to accessing health care:

1. Cost. The prohibitive cost of medical care is, and has been, the number one barrier for individuals and families. According to the KFF, nearly half of U.S. adults report having difficulty affording health care costs.
   - Health insurance. Unequal access to insurance is a major contributor to health disparities. In many cases, health insurance is unaffordable unless it’s offered through a person’s employer. For the millions of people without employer-sponsored health insurance, it means delaying or missing preventive visits to the doctor and dentist, and being unable to afford medications and treatments. The lack of health insurance coverage affects many low-income individuals, and because of the intersectional social determinants of health, it’s an issue that disproportionately affects Black and Latine/x communities.
   - Medical debt. 41% of US adults said they have debt caused by medical or dental bills. Once again, this is a burden shared by Black and Latine/x adults, people with uteruses, parents, and individuals with low incomes.
   - Related costs. Aside from the actual medical bills, there are a number of other financial factors that impact a person’s situation, including the rising cost of transportation, childcare expenses, and rent/mortgage payments.

2. Discrimination and bias. Discrimination occurs across interpersonal and institutional levels, and it is perpetuated by both conscious and unconscious bias. Racism, homophobia, transphobia, and sexism may not be as easy to quantify as something like dollar amounts of medical debt—but these forms of oppression have serious consequences.
   ‍Within BIPOC communities:
   - The Black maternal health care crisis—Black birthing people are 3x more likely to die as a result of pregnancy and childbirth than white birthing people—is a direct result of health inequities caused by racism, oppression, and a lack of access to equitable care.
   - When surveyed in one study, Black Americans reported stigma as a reason for not seeking treatment for depression.
   - Latine/x adults seeking access to HIV primary care reported stigma as a barrier in addition to language and beliefs.
   ‍Within LGBQ and TGNC communities:
   - LGBT adults in New York City reported barriers like a lack of LGBT-tailored services, as well as a hesitancy to seek LGBT-tailored care either because of fear of discrimination, or a lack of awareness of available resources.
   - Due to fear of discrimination and homophobia, lesbian and bisexual women are more likely than heterosexual women to delay treatment or avoid preventive health care.
   - A survey of physicians revealed that a lack of training and lack of exposure to transgender patients were the main reasons for failing to provide equitable care to TGNC individuals.
   - Discrimination related to MPV has disproportionately affected LGBTQIA+ communities. Misinformation has complicated the public health crisis, by being labeled as a “gay disease” and the media’s continued use of the racist term, “monkeypox”.
   ‍Financial discrimination.
   - Medicaid patients already experience barriers to care if they live in an area where few health care providers accept Medicaid. But patients that have found clinicians that accept Medicaid have reported unfair treatment or judgment because of their coverage.

3. Access. Patients can run into issues accessing care for a number of reasons. Sometimes it's a literal block, like a medical building without a wheelchair ramp, and other times it arises out of a multitude of complications, like not being able to take the day off of work in order to drive a relative to a distant specialist appointment. Or, a caregiver is unable to find a replacement in their absence during an appointment.  
   ‍Accessibility.
   - A focus group that surveyed doctors’ attitudes towards treating people with disabilities confirmed that doctors often feel overwhelmed by treating patients with disabilities, don’t have the time or the facilities to accommodate them, and do not feel that they are being adequately reimbursed.
   - Aside from having issues with wheelchair accessibility in doctor’s offices, disabled patients find that they may have their appointments canceled, or in some cases, even told to seek care elsewhere.
   - Physically disabled cisgender women seeking breast cancer treatment have reported incomplete examinations from their wheelchairs, as well as fearing injury when being moved to an examination table.
   ‍Transportation.
   - Limited access to transportation can cause patients to miss appointments and prescription refills, either because of unreliable public transportation, not owning a car, or an inability to afford gas.
   - Many individuals also have trouble getting off of work, and/or securing childcare in order to make doctor’s appointments.
   - Distance is also a major issue, as 21% of Americans live in rural areas, but only 10% of clinicians practice in these areas. In fact, 80% of counties across the US are known as “care deserts,” which are areas lacking facilities that help individuals and families maintain their health. The current shortage of health care providers only exacerbates this issue.
   ‍Technology.
   - Telemedicine can alleviate some of the strain caused by distance and lack of transportation, but the technology itself can be a barrier in some cases as it requires a device, a reliable internet connection, and a level of digital literacy.
   - Adults over 65 are most likely to need chronic disease management, but only 55%–60% own a smartphone or have internet at home. They may also have trouble navigating websites and apps required to access telemedicine services.

4. Health literacy and language barriers. ‍Language barriers affect patients who are seeking care in person as well as via telemedicine, whereas barriers caused by health literacy may not be immediately apparent, but they can have long term consequences.
   ‍Health literacy.
   - Patients may not know the best place to seek care for their issue and may end up visiting the emergency room as a result. This issue is acute for people who have untreated mental health conditions, and for those who are experiencing homelessness. Patients who visit the ER for a mental health condition have almost a one in three chance of returning within 30 days, and medical debt quickly accumulates—for an uninsured person, the average emergency room visit costs nearly ten times more than a regular office visit.
   - Using health information is not the same as understanding it. A person can read information, but a lack of health literacy can prevent them from incorporating healthy behaviors into their day-to-day life or taking advantage of the resources that are available to them. For example, a birthing person may see a postpartum depression information poster during their doctor’s appointment, but they may not recognize their own symptoms or know that joining a support group is an option for them.
   Language barriers.
   - As 1 in 5 American households speak a language other than English, a lack of translation services available within health systems is a widespread problem, affecting everything from printed patient materials to telemedicine.
   - For many families, relatives become default translators, which can place an unfair burden on children, or raise concerns about patient privacy.
   - Deaf patients often do not have access to sign language interpreters during appointments, which causes confusion, mistrust, and an inability to advocate for themselves.
   - When translation services are available, they can be complicated to integrate. According to a recent study, third-party translation services were difficult for patients to integrate into their Zoom telemedicine appointments.

How clinicians can help address barriers to care.

‍Policy changes are necessary to address these system-wide barriers and make health care more equitable. This requires research, investing in health system infrastructure, and adopting new technology across all patient touchpoints. But individual clinicians can also help address these barriers in a number of ways:

• Awareness. The first step clinicians can take is educating themselves on the barriers to accessing health care and social determinants of health, and how they intersect to disproportionately affect BIPOC, LGBQ, TGNC, and low-income communities.
• Cultural competence. Clinicians can learn about patient identities other than their own and how to best deliver care to diverse communities through cultural competence training. This can make it easier to match patients with the right clinicians, and also help improve the entire patient experience.
• Recruit culturally diverse health professionals. Clinicians can invest in hiring, retaining, and training staff who represent culturally diverse communities and understand the unique health care needs of these communities.
• Make your physical location more accessible. Clinicians can choose to spend funds on technology, building construction, staff, or other systems that would improve accessibility, and/or expand office hours or locations to make it easier for patients to access appointments.
• Provide interpreter services for in-person and telemedicine visits. Clinicians can make sure health education materials are also available in multiple languages, and frontend staff are fluent in the languages of your patient populations.

Research shows that inclusive care is proven to generate better health outcomes. ‍Book a demo with Violet today to learn how our standardized cultural competence upskilling and credentialing platform can mutually benefit your care delivery team as well as your patients.