Overcoming barriers to providing equitable healthcare
April 28, 2022
In recent years, we’ve come a long way in addressing access to healthcare, but there is plenty of work still to be done. Healthcare services need to be accessible—meaning convenient, equitable and affordable—so that people may truly benefit from them. Our 2021 Accenture Health and Life Sciences Experience Survey of nearly 1,800 people in the United States revealed that 1 in 4 people said their access to healthcare has been better since the onset of the COVID-19 pandemic. On the other side of the coin, 20% say their access is slightly or much worse.
Many healthcare organizations have tapped into the power of technology plus human ingenuity to make care more accessible. The pandemic forced providers to quickly stand up virtual services so that people could continue to access health services when in-person visits weren’t as safe. Digital tools made it easier to consult with doctors, schedule appointments and track one’s own health. Yet at the same time, these tools aren’t solving for different fundamental issues related to access.
Let’s look closer at some of these issues and, more importantly, how healthcare organizations can help resolve them.
Healthcare organizations have long been struggling with a staffing shortage across clinical and non-clinical roles. The pandemic exacerbated the existing problems and we quickly learned that there is no slack in the system. Hospitals simply can’t run at capacity when they aren’t staffed to full capacity. Elective services quickly become overcrowded. Patients can’t get the care they need when and where they need it.
A report by the Association of American Medical Colleges states that there is an expected shortage of between 37,800 and 124,000 physicians by 2034.1 Staffing issues are even more endemic in rural settings and low-income urban areas that are underserved. Clinicians aren’t always willing to live in and serve these communities. Only 1% of residents who graduated from a US-based medical school would prefer to practice in a town of 25,000 people or less.2
Health systems must recognize their obligation to provide equitable care to the people of these communities and provide other resources if doctors are not locally available. This might include lower cost or alternative care models, such as telemedicine and mobile health services. Healthcare organizations can analyze disparity data across marginalized or underserved populations to understand how they can make care more accessible and equitable.
Health systems may need to affiliate with other enterprises, stakeholders and governments to offer these services. Medical schools can be part of the solution. For example, the California Oregon Medical Partnership to Address Disparities in Rural Education and Health (COMPADRE) is striving to place more physicians in rural and underserved communities by reaching out to those communities themselves to help identify candidates who may want to receive assistance with their medical training and then ultimately return to practice in their hometowns.3
Even at times when we have enough doctors and clinicians “on paper,” there is a mismatch in the availability of specialty services in rural areas. People in non-urban regions either cannot access these services, or they have to travel far to get the care they need as specialists tend to congregate in urban areas. What’s more, underserved in the US are often insured by Medicaid—and many providers aren’t willing to accept that insurance. More than half of uninsured US residents are people of color.4
Waymark uses technology to improve access and outcomes for Medicaid patients. The organization partners with Medicaid managed care organizations to provide services and interventions that are not always available to this population.
Telemedicine is a good solution to the lack of access to specialty services. Virtual care removes several boundaries to access, however, not everyone can get care this way due to lack of technology in the home or low digital literacy. The elderly or low-income families are less likely to have a computer in the home. And among those who have access to a computer, 52 million Americans do not know how to use it properly.5 This is why we cannot rely on telemedicine alone to equitably solve the mismatch of supply and demand.
I’m encouraged by the rise in startups that are offering online visits and deploying other services, such as labs, in rural areas. For instance, Dispatch Health sends two medical professionals along with a medical technician to a patient’s home to offer a variety of services—from treating chronic diseases to performing lab tests.
Patients have a variety of preferences about how and when they want to receive care, the types of services they want to receive, the data they are comfortable sharing and more. These preferences certainly vary among individuals, but we also see some common differences among ethnic groups. To be equitable, health organizations must strive to understand the populations they serve and their preferences about their healthcare experience. These preferences may derive from their culture, socioeconomic situation, education level or other circumstances.
For instance, some groups are reluctant to access certain services where there is a perceived stigma, such as mental healthcare. Accenture research showed that 20% of Americans with common mental health issues had not taken any action to address their condition in the past three years.6 There are other barriers to care, such as issues with transportation, taking time off work or securing childcare. Linguistic and cultural differences among immigrant populations pose equity challenges, but these must be overcome, or people will not receive the care they need and deserve. In fact, the majority of US states have met less than 50% of mental healthcare needs among their populations, citing dire provider shortages and vast disparities across racial and ethnic groups.7
Digital innovation, strategic communications and great experience design could solve many of these issues, but healthcare providers must first understand existing preferences and perceptions. Even if we solve the aforementioned supply and demand issues, we can only solve the equity issues if we understand preferences from an experience standpoint and find ways to be more flexible in meeting people on their own terms.
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As I said earlier, many strides have been made in making care more accessible to a variety of populations. Technology played a big role in making these strides, but we can do more to make care equitable while being accessible.
We can acknowledge our commitment to underserved communities and find creative ways to partner with others to provide the services these people cannot access in their own backyards. We can recognize the mismatch of supply and demand and look at ways to blend physical and virtual care to make services more accessible to a variety of populations. We can also understand and respond to the different preferences people have. By embracing them rather than ignoring them, we can improve care while building long-term relationships.
Let’s continue to make access a priority.
1The Complexities of Physician Supply and Demand: Projections from 2019 to 2034
22019 Survey of Final-Year Medical Residents
3California Oregon Medical Partnership to Address Disparities in Rural Education and Health
4Understanding Barriers to Minority Mental Health Care
5A Description of U.S.Adults Who Are Not Digitally Literate
6Accenture Behavioral Health Consumer Survey, 2020
7Mental Health Care Health Professional Shortage Areas (HPSAs)