This summary of the literature on Access to Health Services as a social determinant of health is a directly specified assessment that is not planned to be extensive and may not resolve all measurements of the concern. Please note: The terms used in each summary is consistent with the respective recommendations. For extra info on cross-cutting subjects, please see the Access to Primary Care literature summary.

Related Objectives (4 )

Here's a photo of the objectives associated with topics covered in this literature summary. Browse all goals.

Increase the percentage of teenagers who had a preventive healthcare see in the past year - AH-01 Increase the percentage of people with health insurance - AHS-01 Increase the percentage of individuals with dental insurance coverage - AHS-02 Increase the percentage of adults who get suggested evidence-based preventive health care - AHS-08

Related Evidence-Based Resources (5 )

Here's a snapshot of the evidence-based resources connected to topics covered in this literature summary. Browse all evidence-based resources.

Breast Cancer: Screening Cervical Cancer: Screening Colorectal Cancer: Screening Improving Access to Oral Healthcare for Vulnerable and Underserved Populations Oral Health in America: A Report of the Surgeon General

Healthy People 2030 organizes the social factors of health into 5 domains:

Economic Stability Education Access and Quality Healthcare Access and Quality Neighborhood and Built Environment Social and Community Context Literature Summary

The National Academies of Sciences, Engineering, and Medicine (previously understood as the Institute of Medicine) define access to health care as the "timely use of individual health services to attain the best possible health results."1 Many people face barriers that avoid or restrict access to required healthcare services, which may increase the threat of bad health outcomes and health disparities.2 This summary will discuss barriers to health care such as lack of health insurance, poor access to transportation, and minimal health care resources, with a special concentrate on how these barriers impact under-resourced neighborhoods.

Unequal circulation of healthcare protection contributes to disparities in health.2 Out-of-pocket healthcare costs may lead people to delay or give up needed care (such as medical professional check outs, dental care, and medications),3 and medical financial obligation prevails amongst both guaranteed and uninsured people.3,4 People with lower incomes are often uninsured,5,6,7,8 and minority groups represent over half of the uninsured population.9

Lack of health insurance coverage may adversely affect health.9,10 Uninsured adults are less most likely to get preventive services for chronic conditions such as diabetes, cancer, and cardiovascular disease.10,11 Similarly, children without medical insurance protection are less most likely to receive suitable treatment for conditions like asthma or vital preventive services such as dental care, immunizations, and well-child check outs that track developmental turning points.10

In contrast, research studies reveal that having medical insurance is associated with improved access to health services and better health monitoring.12,13,14 One study demonstrated that when formerly uninsured grownups ages 60 to 64 years ended up being eligible for Medicare at age 65 years, their use of basic medical services increased.13 Similarly, providing Medicaid protection to previously uninsured adults considerably increased their opportunities of receiving a diabetes medical diagnosis and utilizing diabetic medications.15 Medicaid coverage is also vital for enabling children with special health needs or chronic illnesses to access health services. The Children's Health Insurance Program (CHIP) offers sole protection for 41 percent of kids with unique healthcare requires.16 Many health care resources are more widespread in neighborhoods where locals are well-insured,10 however the type of insurance coverage individuals have may matter also. Medicaid patients, for circumstances, experience gain access to problems when residing in locations where few physicians accept Medicaid due to its decreased reimbursement rate.14,17,18

Medical insurance alone can not eliminate every barrier to care. Limited availability of healthcare resources is another barrier that may minimize access to health services and increase the risk of bad health results.19,20 For example, physician lacks might mean that clients experience longer wait times and delayed care.18

Inconvenient or unreliable transport can disrupt consistent access to health care, potentially adding to unfavorable health outcomes.21 Research has actually shown that individuals from racial/ethnic minority groups who had actually an increased threat for extreme illness from COVID-19 were most likely to do not have transport to healthcare services.22 Transportation barriers and domestic segregation are also associated with late-stage presentation of specific medical conditions (e.g., breast cancer).23,24,25

Expanding access to health services is an important step towards minimizing health variations. Affordable health insurance is part of the solution, but elements like economic, social, cultural, and geographical barriers to health care should likewise be thought about,20 as must brand-new methods to increase the effectiveness of healthcare shipment.18,26,27 Further research study is required to better comprehend barriers to health care, and this extra evidence will help with public health efforts to attend to access to health services as a social determinant of health.

Citations

Institute of Medicine (U.S.) Committee on Monitoring Access to Personal Healthcare Services. (1993 ). Access to health care in America (M. Millman, Ed.). National Academies Press.

Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care (2003 ). Unequal treatment: Confronting racial and ethnic disparities in healthcare (B. D. Smedley, A. Y. Stith, & A. R. Nelson, Eds.). National Academies Press.

Pryor, C., & Gurewich, D. (2004 ). Getting care but paying the cost: how medical financial obligation leaves numerous in Massachusetts dealing with hard options. The Access Project.
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Herman, P. M., Rissi, J. J., & Walsh, M. E. (2011 ). Health insurance coverage status, medical debt, and their influence on access to care in Arizona. American Journal of Public Health, 101( 8 ), 1437-1443.

Hadley, J. (2003 ). Sicker and poorer - the repercussions of being uninsured: A review of the research study on the relationship in between medical insurance, healthcare use, health, work, and earnings. Medical-Car Research and Review, 60(2_suppl), 3S-75S.

Franks, P., Clancy, C. M., & Gold, M. R. (1993 ). Health insurance coverage and death: Evidence from a national associate. JAMA, 270( 6 ), 737-741.

Zhu, J., Brawarsky, P., Lipsitz, S., Huskamp, H., & Haas, J. S. (2010 ). Massachusetts health reform and disparities in protection, access and health status. Journal of General Internal Medicine, 25( 12 ), 1356-1362.

DeNavas-Walt, C. (2010 ). Income, poverty, and medical insurance protection in the United States (2005 ). Diane Publishing.

Majerol, M., Newkirk, V., & Garfield, R. (2015 ). The uninsured: A primer. Kaiser Family Foundation Publication, 7451-10.

Institute of Medicine (U.S.) Committee on Health Insurance Status and Its Consequences. (2009 ). America's uninsured crisis: Consequences for health and healthcare. National Academies Press.

Ayanian, J. Z., Weissman, J. S., Schneider, E. C., Ginsburg, J. A., & Zaslavsky, A. M. (2000 ). Unmet health needs of uninsured grownups in the United States. JAMA, 284( 16 ), 2061-2069.

Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., ... & Finkelstein, A. N. (2013 ). The Oregon experiment - results of Medicaid on medical outcomes. New England Journal of Medicine, 368( 18 ), 1713-1722.

McWilliams, J. M., Zaslavsky, A. M., Meara, E., & Ayanian, J. Z. (2003 ). Impact of Medicare coverage on basic clinical services for previously uninsured adults. JAMA, 290( 6 ), 757-764.

Buchmueller, T. C., Grumbach, K., Kronick, R., & Kahn, J. G. (2005 ). Book evaluation: The result of medical insurance on healthcare usage and implications for insurance growth: An evaluation of the literature. Healthcare Research and Review, 62( 1 ), 3-30.

Myerson, R., & Laiteerapong, N. (2016 ). The Affordable Care Act and diabetes medical diagnosis and care: Exploring the prospective impacts. Current Diabetes Reports,16( 4 ), 1-8.

Musumeci, M. (2018 ). Medicaid's role for children with unique health care needs. Journal of Law, Medicine & Ethics, 46( 4 ), 897-905.

Decker, S. L. (2012 ). In 2011 nearly one-third of physicians stated they would not accept new Medicaid patients, however increasing charges might help. Health Affairs, 31( 8 ), 1673-1679.

Bodenheimer, T., & Pham, H. H. (2010 ). Medical care: Current problems and proposed solutions. Health Affairs (Project Hope), 29( 5 ), 799-805. doi: 10.1377/ hlthaff.2010.0026.

National Association of Community Health Centers and the Robert Graham Center. (2007 ). Access rejected: An appearance at America's clinically disenfranchised. National Association of Community Health Centers, .

Douthit, N., Kiv, S., Dwolatzky, T., & Biswas, S. (2015 ). Exposing some crucial barriers to health care access in the rural USA. Public Health, 129( 6 ), 611-620. doi: 10.1016/ j.puhe.2015.04.001.

Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013 ). Traveling towards disease: Transportation barriers to healthcare access. Journal of Community Health, 38( 5 ), 976-993. doi: 10.1007/ s10900-013-9681-1.
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Clay, S. L., Woodson, M. J., Mazurek, K., & Antonio, B. (2021 ). Racial variations and COVID-19: Exploring the relationship between race/ethnicity, individual factors, health access/affordability, and conditions associated with an increased severity of COVID-19. Race and Social Problems, 1-13. doi: 10.1007/ s12552-021-09320-9.

Dai, D. (2010 ). Black property segregation, variations in spatial access to health care facilities, and late-stage breast cancer diagnosis in metropolitan Detroit. Health & Place, 16( 5 ), 1038-1052. doi: 10.1016/ j.healthplace.2010.06.012.

Tarlov, E., Zenk, S. N., Campbell, R. T., Warnecke, R. B., & Block, R. (2009 ). Characteristics of mammography facility locations and stage of breast cancer at medical diagnosis in Chicago. Journal of Urban Health: Bulletin of the New York City Academy of Medicine, 86( 2 ),196 -213. doi: 10.1007/ s11524-008-9320-9.

Wang, F., McLafferty, S., Escamilla, V., & Luo, L. (2008 ). Late-stage breast cancer medical diagnosis and health care access in Illinois. Professional Geographer, 60( 1 ), 54-69. doi: 10.1080/ 00330120701724087.

Green, L. V., Savin, S., & Lu, Y. (2013 ). Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication. Health Affairs (Project Hope), 32( 1 ), 11-19. doi: 10.1377/ hlthaff.2012.1086.

Rieselbach, R. E., Crouse, B. J., & Frohna, J. G. (2010 ). Teaching main care in community health centers: Addressing the workforce crisis for the underserved. Annals of Internal Medicine, 152( 2 ), 118-122.