Healthcare & Access

The Cost of Distance: When Healthcare Becomes a Barrier, Not a Right

By Simrah Chhipa, YouthCare Connect

Low-income communities face significantly high health risks due to limited access to adequate healthcare. What does it mean when medical care exists, but cannot reach those who need it the most? In underprivileged environments, people are often exposed to unsanitary conditions, disease, overcrowded housing, and limited access to preventive care, all of which increase their need for medical support. This article argues that limited access to healthcare in low-income communities leads to health risks and worsens long-term outcomes for vulnerable populations.

Key Definitions

Low-income communities refer to individuals living in areas where a census tract does not meet the average household income. According to the USDA Economic Research Service (ERS) Food Access Research Atlas documentation, A tract with either a poverty rate of (20%) or more, or a median family income less than (80%) of the State-wide median family income; or a tract in a metropolitan area with a median family income less than (80%) of the surrounding metropolitan area median family income.

Furthermore, access to healthcare means more than just having hospitals and medications available nearby. It also includes insurance coverage, affordability of treatment, and availability of providers. As Rod Blagojevich describes, “Healthcare is not a privilege. It’s right. It’s a right as fundamental as civil rights. It’s a right as fundamental as giving every child a chance to get a public education.” This highlights that healthcare is a necessity that should be universally accessible to everyone, not a service that is available in one place but not in another. Furthermore, healthcare inequality refers to systematic, avoidable, and unfair differences in access to care, health status, and the quality of care across population groups. They are often a result of social, economic, and environmental challenges. Healthcare inequity describes disparities that are unfair and unjust.

Healthcare System Historical Context

The healthcare system used to be simple. It used to be a system of home-based charity and cheap potions, unlike the medical insurance complex it is today. Though it wasn’t as advanced and effective, it used to be so affordable that no insurance was needed. However, in many countries like the U.S., wages were frozen to prevent inflation. As a result, insurance was given to employers as a perk. This transformed access from a system of direct negotiation in which the patient directly pays the doctor, to a web of insurance and federal.

So, although advancements have been made, it has also become unequally accessible. Access to healthcare now depends on money, geography, and historical policies. Care is now managed by the insurance network, which means that if one’s provider isn’t part of the network, one would have to lose access to them. Furthermore, big healthcare systems are buying out small local ones. If a small hospital isn’t profitable enough, especially in low-income areas, it could be closed down. This transformation has made the healthcare system dependent on financial and economic factors, creating more disparities in low-income communities.

The Healthcare Gap

Hospitals, clinics, and medical professionals are widely available in most regions. However, access to them is not guaranteed to everyone. In low-income communities, there lies a visible gap between the existence of healthcare facilities and the ability of citizens to actually access them. Though primary care may seem to be growing, it only grows in places that allow for economic advantage, which still leaves low-income communities with limited access. For instance, in the United States, the rural population faces a 20% higher death rate and a 7% higher rate of “fair” or “poor” health status compared to the urban population. This demonstrates that a wide gap in access to care still remains among regions. Healthcare is not equally distributed, showing that it is based on location rather than the medical needs of people.

Causes of Lack of Access to Adequate Healthcare

This gap between availability and access to adequate healthcare is caused by many structural factors. One of the most significant factors in low-income communities is the financial burden on individuals. Access to healthcare is often closely tied to one’s income, as it determines their ability to pay for medications, treatments, and insurance coverage. As income values remain low, the cost for healthcare services has also increased.

According to studies from the U.S. National Health Interview Survey (NHIS), 8.5% of people do not receive medical care due to its high cost, while 14.7% delay dental care, and 5.6% of people delay prescription medication. This demonstrates how financial restrictions affect whether individuals can access essential medical needs. It also forces many individuals to prioritize affordability over immediate health needs. Cost has shaped a patient’s medical decisions rather than their own health.

Another factor deepening healthcare inequality is the lack of insurance coverage, which adds to the high cost of available healthcare services. Low-income communities, in which the sickest populations live, are often found to be uninsured. This holds back patients in those areas from getting the proper care they need, or makes them delay it for a long time. This could lead to them facing threatening health risks.

Additionally, a lot of medication is not covered by insurance, forcing patients to bear high out-of-pocket costs. As a result, patients experience a hard time managing their health while also facing serious financial strains. Gaps in insurance coverage cause medical and financial vulnerability, which limits consistent access to care.

However, the lack of access to adequate care goes beyond financial strains. In many regions, there is an unequal distribution of healthcare facilities. In wealthy communities, there are more clinics and hospitals available. However, in low-income communities, they are rapidly closing down. In a joint analysis by the Milwaukee Journal Sentinel and the Pittsburgh Post-Gazette, it was found that 230 hospitals have opened in wealthier areas. This portrays how the healthcare systems follow economic advantages rather than the needs of the population. For this reason, those in low-income places find themselves with only a few options for care. This delays treatments and health conditions for many people. Additionally, the facilities found in the underprivileged communities are often unsanitary while containing low-quality equipment and treatment options.

Effects of the Lack of Access to Healthcare

Poor health is a direct outcome of poverty and limited access to healthcare, especially in underserved communities. It increases the rate of disease burdens among individuals who are unable to receive timely access to care. These diseases include chronic conditions such as cardiovascular disease, kidney disease, and lung disease. If an individual experiencing these conditions is able to access treatment, it could become mortal.

Lack of insurance coverage drastically threatens one’s health in those areas. Individuals who are uninsured are less likely to receive preventive care. This shows how illnesses often go unnoticed until they become serious. As a result, they are often diagnosed with diseases at later stages and miss out on necessary treatments. By the time they receive care, it becomes less effective. Furthermore, uninsured individuals are also more likely to die from treatable conditions like a heart attack, increasing the mortality rate in low-income communities. A study shows that those without health insurance had 40% higher mortality than the insured in the age range 17–64. Kidney disease has become more common in low-income areas as the lack of insurance coverage prevents people from getting dialysis treatment. Overall, this portrays how lack of insurance coverage does not only affect access, it also threatens survival.

In underprivileged environments, the early detection and effect of treatment is significantly influenced by access to healthcare. Research shows that in countries with high rates of screening and access to medical care, patients are able to detect conditions such as cancer at an early stage. Those who have limited access receive a diagnosis too late and are forced to delay their treatment. This is connected to higher rates of survival in comparison to countries for lower access. For instance, studies show that in communities within the United States, patients who are uninsured have 40% higher mortality rate than those who have insurance, highlighting the impact the lack of access has on survival.

Solutions

Many measures have been taken to combat the lack of access to healthcare in vulnerable communities. These include hospital-led initiatives, policy reforms, and community-based programs. These measures all aim to reduce financial and structural barriers, as well as improve the quality of healthcare in low-income communities.

In the United States, a joint state and federal program called Medicaid was created to provide free or low-cost health coverage to those who have limited income. It provides stability to the U.S healthcare system, especially in rural areas. It boosts state economies by covering over 60% of long term care, covering 1 in 5 people. This includes eligible low-income adults, pregnant women, children, senior citizens, and people with disabilities. Many states allow those who have income 133% under the federal poverty line to be eligible for Medicare.

Medicaid improves the health of the community and supports many healthcare facilities to provide care. With Medicaid, patients are able to receive early detection and prevention of chronic illnesses and diseases. For instance, this program allows people access to cancer screenings. As stated by Kaiser Permanente, “78% of our Medicaid members were up to date on breast cancer screening, and 76% were up to date on cervical and colorectal cancer screenings in 2022.” People were even able to receive cancer treatments even if they were uninsured.

Furthermore, Medicare allowed those who are uninsured to keep their high blood pressure under control, reducing the risk of heart disease and stroke. Through this support, Medicaid has lowered mortality rates for patients with cardiovascular disease, diabetes, lung cancer, and breast cancer. Studies have shown that Medicaid expansion reduced the rate of all-cause mortality by 3.6% for adults ages 20-64 and by 9.4% for adults ages 55-64.

Medicaid has also made the community healthier by providing stability in hospitals, particularly in rural and underserved communities. It provides the funding for hospitals in those areas to remain open and offer qualitative care that is effective. Medicaid expansion has reduced the rate of uncompensated care. This has been important in areas where hospital closures have been increasing, since closures can stop access to essential care. Other forms of Medicaid programs in other nations have also helped combat the lack of access to healthcare in their low-income communities.

In addition to support from programs, organizations like the American Hospital Association have tried to combat the lack of access to healthcare by ensuring that hospitals are providing equal care to all patients. In the communities that don’t have enough healthcare professionals, the AHA has sent trainers to train doctors who may have once been unqualified. The AHA emphasizes the importance of having equity and equality so that all communities, regardless of income, can get their patients the proper care that they need. Moreover, members within their own communities have taken their own initiatives to support those who are struggling locally. They organize first aid kits, health panels, and opportunities for professionals to provide care to people in those areas.

Closing

The availability of adequate healthcare in communities should not be based on their location, income, or economic status. However, for many places, these factors are still what decide whether care will reach those who need it before it’s too late. Moving forward, healthcare systems should emphasize equality and justice, in addition to providing medical care.