Adie and I decided to write about healthcare accessibility after discussing what I witnessed this summer. This past summer I interned at a Physical Therapy facility - for the sake and reputation, I will not be stating the company’s name. In the time that I interned, two patients specifically caught my eye. Not due to their reasoning of being at therapy, but for the reason that they could not seek further help. Patient X is a male in his early to mid 50s, he had multiple strokes and needed rehabilitation. Due to his insurance, the condition he was in was not worse enough to continue therapy for longer than four months. His disability was not severe enough to receive the assistance he needed, but it is severe enough to lead him to his death bed if no continued therapy. Patient Y is a male, 30 to 40 years old, and he is deaf. Because he is deaf and none of the therapist know sign language, his condition has not improved at all. His mother, who brought him, would try and help but nothing was working. The company had never had this “problem” before, so they had no clue what to do. Thankfully, I told them that I personally knew ASL and asked to work with him directly - under the instructions of the licensed therapist. During the time I got to work with him, he started to show improvement. He walked for the first time in six months with me. Unfortunately, I had to leave due to school, but before I left, I taught all the therapists how to sign commands, and praising phrases to patient Y. I did this so he could continue to improve his health. I also did this, for future patients; it makes them feel welcomed and involved. Both of these patients have been majorly restricted on their health care due to their health conditions. How is this humane to do, to neglect someone in the way it is legal?
In today’s society, people rely on their healthcare professionals to take care of them in times when they are sick or injured. However, insurance puts a limit on their clients. Who should patients trust more; an insurance employee saying their client doesn’t need medical attention or should the people trust the medical professional who sees the patient frequently? This is one area where healthcare insurance fails their clients. Instead of allowing their patient to completely heal from a sickness or injury, insurance will cut them off before their Plan of Care (PoC) is completed. Some people never have the opportunity to seek the correct medical care from the start. However, if they do have the means to access medical care, usually within a few weeks the same injury or illness is present again which makes the patient/client have to go through the whole process of getting their healthcare insurance to approve them for another medical visit. If they would let the healthcare professionals finish their PoC the first time around, people would not have to keep going in the same circle of seeking treatment. This also causes people to not even go to healthcare professionals because they do not want to deal with the whole process. This is a major problem. What factors contribute to limiting access to healthcare?
Before even trying to seek medical care, an individual can be harmed from the start. Angier et al. highlights that although insurance programs have expanded coverage for the poor and care to vulnerable populations, many Americans still do not have access to basic medical care (2007). In their study, they identify the various barriers families experience in accessing medical care. They found that the three main barriers families experience are lack of insurance coverage, poor access to services, and unaffordable costs (Angier et al. 2007). This is noteworthy because it emphasizes that due to low socioeconomic status, individuals are not even able to receive the correct care, which ultimately leads to many health issues in the present and future. Even if families are able to overcome the obstacle of insurance access, the elevated costs of medical care is one obstacle many cannot overcome. Not only are families intimidated by the costs of medical care, Angier et al. express that individuals are intimidated to even call medical care clinics because of the fear of answering the question “What’s your insurance?” (2007). Because of the heavy costs, and complicated, yet almost impossible coverage of insurance, families of low socioeconomic status are unable to receive direct, medical care. This ultimately makes them feel invisible to health insurance companies, and feel as if their needs are not important enough, so they suffer alone.
By putting a cost on everything, the patient is limited by what their socioeconomic status is. If one knows that they cannot afford a procedure, treatment, or medications, this is when they usually turn to their healthcare insurance to help get the medical attention needed. When they deny or put a cap on the treatment, it limits the attention the patient can get. Since when did society allow insurance companies to control one’s health care plan? Someone who has no medical knowledge gets to determine whether or not another human being gets the correct medical care.
In addition to families and individuals that have low socioeconomic status, the homeless are also heavily impacted by healthcare access and costs. Nickash and Marnocha highlight that although many people in society see homelessness as an outcome of laziness, they explain that homelessness is actually a social problem that is increasing (2009). Because homelessness is such a major problem that is continuously increasing, there are many healthcare challenges. Marnocha et al. identify the barriers homeless individuals experience in relation to health care access (2009). In their study, the main theme for healthcare experiences of the homeless was external locus of control, specifically the lack of affordability was a common denominator once again (Marnocha, Nickash 2009). This finding emphasizes how the homeless feel as if they cannot control necessities in their life, such as medical care, because society has already labeled them as irresponsible and lazy. This also goes along with the concept of homelessness being socially constructed because people view those who are homeless as lazy and if they just work harder they would not be homeless. However, what people do not realize is that people who are homeless work very hard to improve their situation, but society and institutions have already set them up to fail time and time again. Additionally, Marnocha et al. found that it was reported that there are no compassionate healthcare providers, which impacts experiences of families and individuals heavily (2009). This shows that our society does not truly care about its people, and individuals who are in charge just stick anyone who is available in positions that need compassion and understanding. Having someone who is compassionate and helping can make all the difference, especially when one does not have comfort and love from other aspects of their life, such as a job, family, or friends.
In relation to socioeconomic status, many people do not have reliable transportation options to get to and from a medical facility. Transportation can be a challenge in all areas, including both rural and urban. In their book, Kathryn Edin and Luke Shaefer highlight how transportation can be challenging in a rural area, such as the Mississippi Delta, and an urban area, such as Chicago (2015). In rural areas, there are not as many options for transportation to cities where the medical offices are located. Additionally, if those medical facilities are too far from one’s household, there are usually few to none medical facilities in rural areas. So, receiving sufficient medical care is far out of reach for many people living in rural areas, especially low-income rural areas. Even though urban areas have more medical facilities within cities, that does not mean that it is more accessible and affordable for their patients. For example, once someone gets reliable transportation to a medical facility, they can be troubled with longer lines, steep costs, and less adequate medical attention because of the high population of patients. All of this Edin and Shaefer emphasize show the complications of geographical location in relation to medical care access. Specifically, those of low-income areas and minority groups severely lack transportation and support for medical needs. Although many people do not comprehend that transportation is a disability, it limits one to how and when they can get to and from a facility that is needed for adequate living.
Furthermore, once someone is able to access reliable transportation to receive medical care, the medical professionals may not be able to communicate effectively. Language barriers are very common and can heavily impact quality medical attention. Health literacy is the ability to understand the medical information about yourself, given to you by a medical professional, intended to make appropriate decisions for one’s health (Sudore 2006). By limiting health literacy, not only do agencies impact the people who have language barriers, but it also impact elderly adults. For elederly adults, they typically have a higher rate than most when it comes to chronic illness, higher doses of medicine, and higher rates of emergency room visits and hospitalization records. This is due to poor healthcare access (Sudore 2006). They are not receiving the medical assistance and services they need to be well again. There are many factors to poor/limited health care access, but where does limited health literacy come into play? With limited health literacy, agencies are taking away people’s chance at getting better before they are even offered the chance. If they know they cannot afford it or understand the PoC clearly, more times than not they will not take the right path. They will just walk away from it all.
Another essential point is the quality of medical care that impacts those who are disabiled. Deaf people have poorer health and use health care services differently than hearing people. The reasons for this are unclear. Deaf people continue to report difficulties accessing health care even in the years since the passage of the Americans with Disabilities Act of 1990 (ADA) (Steingberg et al. 2019). People who are deaf and use American Sign Language (ASL) have much in common with members of other linguistic and cultural minority groups. These similarities include limited access to English language-based communication, infrequent contact with clinicians familiar with their language and culture, and the challenging experience of working with family members and friends as interpreters (Steinberg et al. 2019). Not all associate with the cultural minority group. In the deaf community the ones that identify with the minority are the ones that are Deaf with a capital D. The ones that do not associate are deaf with a lowercase d, which means lack of hearing. The deaf person generally lets you know who they associate with and how they identify themselves. Some participants stated that having a signing clinician was a positive experience. They felt free to really express how they were feeling and what was actually going on with their health without masking it. When a patient has an interpreter, they feel as if they cannot tell the whole truth due to not wanting to be judged by the interpreter or ashamed of how they are feeling. By communicating directly to the medical professional, not only do you have a better patient/healthcare professional relationship, but also the professional can always treat the patient more efficiently due to having sincere facts (Steinberg et al. 2019). Some steps to solving this complication could go all the way back to schooling. Having the availability for students to take ASL in school to break down the language barrier. Yes, other languages are needed, but the rising need of signing professionals is significant. This is why Deaf people feel as if they are a part of the cultural minority, because there is such limited access to the proper healthcare they need to sustain normal living.
As if all of these circumstances were not sufficient enough, race plays a substantial role in the ever growing obstacles of receiving medical care. Racial and ethnic disparities in health are multifactorial: they reflect differences in biological vulnerability to disease as well as differences in social resources, environmental factors, and health care intervening (Richardson, Norris 2010). It is known that there are many other factors that impact the health status of a person other than healthcare, such as education and income. One has to understand the inequality of this in order to stand up and receive the access and resources needed to sustain a healthy living style. The environment someone lives in has a huge impact on their well being. In saying that, typically races are segregated in where we reside at. For example, people of color generally live in high levels of abandoned houses, live close together, more people to room ratio, etc. These all can affect your health. By living in these areas, one can be exposed to many toxins, pathogens, and carcinogens. Not to take into account the access one has to help services, fresh food and clean water, etc. (Richardson, Norris 2010). The list can go on about how people of color do not get the susatinal help they need to live healthily.
To conclude, there are many areas where health care accessibility is not so easily accessible to everyone. In this paper only a few factors were listed, many more add to this on going list. Additionally, the ongoing obstacles there are for someone to receive the medical care they need emphasizes that there are larger social structures pulling the strings. How our society runs and how people looked upon, such as minority groups, are heavily influenced by larger institutions that tell society who is superior. Ultimately, someone who is in need of medical help should never have a problem receiving the help they need. However, so many people are lacking the opportunity to live a healthier lifestyle because of our broken healthcare system, and what social rules and norms larger structures enforce. Not only does insurance and the cost of medical care have a huge impact on people receiving health care, but a number of factors contribute; whether one is of a different race, different SES class, or has a disability. People have a right to access the standard care of living. Everyone should receive basic standard living healthcare. Only in a perfect world would that happen, and this is not a perfect world.
