Fundamentals · chapter 3 · Healthcare Delivery Systems
Barriers to Healthcare Access
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Barriers prevent needed care
Although a wide range and variety of healthcare systems and facilities are available in the United States, barriers to care may prevent large groups of people from receiving the types of care they need (Agency for Healthcare Research and Quality [AHRQ], 2018a; Center for Health Ethics, n.d.).
Access barrier categories
These types of barriers include geographical (where people live versus where providers are), timing (when providers are available versus when patients need them), and availability (having enough providers available and in practice for the patients who need them).
Sociocultural barriers
Other barriers include sociocultural issues, such as language, religion, and race or ethnicity. Together, these barriers can be as problematic for accessing health care as cost or lack of insurance (Rural Health Information, 2022).
Rural hospital closures
In addition, the rate of closure for rural hospitals is higher than for urban hospitals, particularly in the South. This results in a disproportionate impact on people who are socioeconomically disadvantaged and people of color.
Urban provider distribution
Healthcare providers are more likely to work in urban areas than rural areas. This is most true for specialist providers, such as mental health professionals, surgeons, and/or tertiary care provider s, but it is even the case for primary care provider (PCP) (AHRQ, 2018c).
Restricted daytime hours
The restricted hours (e.g., Monday through Friday, daytime only) at physician offices and clinics are frequently named as a barrier by patients who need to seek care or those who have to have regular treatment visits (Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health [OASH], 2022).
Transportation and missed care
Lack of transportation or limited transportation is one of the primary reasons (other than cost) that patients miss scheduled appointments or do not seek care until they are very sick (OASH, 2022).
Rural transportation limitations
For patients in rural areas, transportation issues can be even more difficult to overcome because public transportation is often unavailable, and they must rely on their own vehicles (if they have them) or the availability of family or friends to assist in getting them to appointments.
Provider shortage areas
In 2021, nationwide there were 8,160 federally designated HPSAs needing primary care practitioners; 7,192 HPSAs needing dental health providers; and 6,464 HPSAs needing mental health providers (HRSA, 2022).
Cost-related delayed care
Regardless of their insurance status, almost half of adult Americans report difficulties affording their healthcare costs, and almost 40 percent have either delayed or not gotten needed medical care (Montero et al., 2022). Further, approximately a quarter of adults report not filling prescriptions, taking less than full doses, or skipping doses due to the costs of medications.
Insurance not sufficient
Simply having insurance is not enough to prevent financial concerns and difficulties accessing health care related to costs.
Uninsured outcomes
However, in 2021, 13.5 percent (approximately 30 million people) of adults over 18 years old in the United States still did not have health insurance (Adjaye-Gbewonyo Boersma, 2022). These individuals are less likely than any other group to receive medical care and are more likely to be sicker and die younger (Adjaye-Gbewonyo Boersma, 2022).
Distrust causes
Distrust in healthcare providers, an intrinsic factor, can arise for many reasons, including previous negative interactions; anxiety about working with a provider of a different race, ethnicity, or gender; and poor health literacy (OASH, 2022).
Racial access differences
For example, in 2013, 14.6 percent of Americans were unable to get care when they needed it because it was unavailable; however, there were significant differences among races (19.8, 19.2, and 13.2 percent of Black, Hispanic, and White persons, respectively) (AHRQ, 2018a).
Terms to know
- Healthcare access
- Healthcare access is a patient’s ability to get healthcare services such as primary, secondary, and tertiary care when and where they are needed.
- health literacy
- People who live in rural areas are more likely to experience provider shortages; less likely to have insurance; more likely to have to travel long distances to receive care; more likely to work in jobs without paid time off work; less likely to trust healthcare professionals to give them quality care or to keep their issues private; and more likely to have limited health literacy (a patient’s ability to understand instructions and education from their providers and be able to actively participate in their care) than other populations (see Chapter 4 Health, Wellness, and Community-Based Health Care) (Rural Health Information Hub, 2022).
- provider shortage
- Not having enough providers for a given population, or provider shortage, is a severe problem throughout the United States.
- disparities
- There are also barriers to care that cause disparities (differences that negatively impact one group over another) in treatment between groups.
- White-coat syndrome
- White-coat syndrome is when a patient experiences elevated anxiety and mistrust related to working with a healthcare provider.
- premium
- Between one-third and one-half of Americans with insurance worry about whether they can pay for their premium (the amount of money they pay each period to subscribe to their insurance) or afford their deductible (the amount of money someone with insurance must pay a provider before the insurance begins paying) (Montero et al., 2022).
- deductible
- Between one-third and one-half of Americans with insurance worry about whether they can pay for their premium (the amount of money they pay each period to subscribe to their insurance) or afford their deductible (the amount of money someone with insurance must pay a provider before the insurance begins paying) (Montero et al., 2022).
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
Before teaching a newly admitted client about a new prescription, what is the nurse's first responsibility?
- Teach the family, since they will manage the medication.
- Ask the provider to explain the prescription instead.
- Assess the client's health literacy.
- Give the client a printed handout to read later.
Answer: Assess the client's health literacy.
Identifying health literacy is a crucial part of assessment and is always the nurse's responsibility before educating. A handout, delegating to the provider, or teaching the family skips the step of finding out how this client understands information.
A client's blood pressure is elevated at a first visit with a new provider, and the client says they always feel nervous in clinics. Which explanation should the nurse consider?
- Provider shortage
- Systemic racism as an extrinsic factor
- Restricted daytime hours
- White-coat syndrome
Answer: White-coat syndrome
White-coat syndrome is elevated anxiety and mistrust with a provider, and vital signs such as blood pressure may be altered, especially with a new provider. Systemic racism, provider shortages, and restricted hours are barriers to access but do not explain an anxiety-related change in vital signs.
A client with Medicare asks the nurse why they will have to pay for new hearing aids. Which response is accurate?
- Medicare does not cover hearing, so a supplementary plan or out-of-pocket payment is needed.
- Hearing aids are covered only for clients with a disability.
- Medicare covers hearing services only after the deductible is met.
- Medicare covers hearing but not dental or prescription drugs.
Answer: Medicare does not cover hearing, so a supplementary plan or out-of-pocket payment is needed.
Medicare does not cover hearing, dental, or prescription drugs, so clients must buy supplementary plans or pay for the services themselves. The other responses invent coverage rules or wrongly say hearing is covered.
A client living in a remote rural area misses several follow-up appointments. Other than cost, which barrier is one of the primary reasons clients miss scheduled appointments?
- Extended clinic hours
- Too many primary care providers in rural areas
- Having dental insurance separate from medical insurance
- Lack of transportation
Answer: Lack of transportation
Lack of or limited transportation is one of the primary reasons other than cost that clients miss appointments, and in rural areas public transportation is often unavailable. Rural areas have fewer, not more, providers, and extended hours reduce rather than create a barrier.
A nurse is working in a clinic that serves a rural community. Which barriers are clients in rural areas more likely to experience? Select all that apply.
- Limited health literacy
- Provider shortages
- Jobs without paid time off work
- Greater access to specialist providers
- Traveling long distances to receive care
Answer: Limited health literacy, Provider shortages, Jobs without paid time off work, Traveling long distances to receive care
People in rural areas are more likely to face provider shortages, long travel, jobs without paid time off, and limited health literacy. Specialist providers are more likely to work in urban areas, so rural clients have less access to them, not more.
A client with poor health literacy says they do not trust what the provider tells them. Which are intrinsic factors that can create disparities in treatment? Select all that apply.
- White-coat syndrome
- Systemic racism
- Infrastructure
- Distrust in healthcare providers
- Lack of education about the importance of primary care
Answer: White-coat syndrome, Distrust in healthcare providers, Lack of education about the importance of primary care
Intrinsic factors relate to personal thoughts, values, and beliefs and include distrust in providers, white-coat syndrome, and lack of education about primary care. Systemic racism and infrastructure are extrinsic factors that come from outside the individual.
Where every quote comes from
Section 3.3 Barriers to Healthcare Access of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.