We’ve all had our reasons for not going to see the doctor.
“I don’t have time.”
“They told my friend she had strep when she really had mono. She lost 30 pounds and now she can’t even fit into the clothing from Gap Kid’s. It’s pretty pathetic. I’d rather suffer than go to the doctor.”
“Have you seen the waiting room? I hate waiting with sick people.”
These excuses may seem reasonable in context, but when you form a habit of avoiding medical care, you weave a complex web of consequences both for yourself, and for society at large.
Beneath these pretexts, there are 3 ubiquitous barriers to quality medical care. While these barriers may appear somewhat negligible, they can yield an avalanche of catastrophic problems in the long term, such as a complex chronic disease requiring costly medical care. Evading primary care exacerbates otherwise preventable health conditions and increases the overall cost of care.
Barrier 1: "It's Inconvenient."Various obstacles make accessing health care simply inconvenient. The following list highlights some of the most common complaints:
- Proximity: The nearest physician's office is ... well, not "near" at all. This barrier is especially common among those in rural communities.
- Means of transportation: Traveling to the nearest doctor's office is too expensive. Some people may not own a car, or can't afford the public transportation needed to make the trek. Others may not be able to afford financial risk of taking time off from their job.
- Time: Many people simply cannot afford to sacrifice the time away from other responsibilities needed to make the commitment of obtaining care. They may have to pick up their children from school and take them to their trombone lessons, or cook dinner for their family, or study for their big exam tomorrow, and… "Oh, goodness! There’s just no time! Give me strength!" Simply traveling to the clinic sounds like one giant headache.
- The waiting room: Beyond having absurd wait times, waiting rooms are swarming with sick patients. People often avoid going to the doctor for treatment of a chronic condition because they don’t want to expose themselves to a contagious, acute illness.
- The exam room: I don't have to say much here. I'm pretty sure all of us have been sitting in a waiting room wondering whether the physician, or PA, or whatever is ever going to return. It's awful.
Of course, these inconveniences didn't materialize out of thin air. Two things stand out as primary causation: First, the predominance of the fee-for-service reimbursement system, which disproportionately favors tertiary care and episodic crisis management, and ultimately forces providers to rush patients through the system. And second, the apparent lack of responsibility by the citizens who need care the most.
Because more and more physicians dread entering the primary care model, the healthcare industry has seen a major reduction in PCPs. More than 56 million Americans—greater than one-fifth of the US population—already live in areas with too few primary care physicians, according to the National Association of Community Health Centers (1).
Hence, primary care appointments have become synonymous with longer wait times and fewer available appointments, and more often than not, people wait until the severity of their health condition outweighs the burden of obtaining care. The result is simply supply and demand.
Barrier 2: "It's Expensive."
Lack of affordability represents an all-too common barrier to care. Various financial obstacles frequently deter patients from obtaining medical services. These include:
- High employee out-of-pocket costs
- The rising prices of prescriptions, x-rays, and other medical services
- Cost of transportation (gas, public transit, etc.)
- Loss of PTO or houry wage due to leaving work in order to obtain care
- Deductibles and copays are often too high
Although these short-term costs seem inordinately expensive, people often lack foresight regarding the long-term costs of neglecting their health, both for themselves and for their employers. When people avoid primary care services, they fail to benefit from preventive services that could help them take control of their health and stabilize a chronic condition before it escalates into a costly claim. According to Milken Institute research, employees suffering from the seven most common chronic conditions will cost US employers $4.2 trillion in 2023 (2).
In an ideal world, informing everyone of this would encourage people to seek primary care and take control of their health. Unfortunately, it's not that simple. Many people simply cannot afford the short-term price of care.
Barrier 3: "It's Confusing."
Let's be honest. America's health system is confusing! If you've ever seen James Cameron's film, Avatar, you may recall trying to decrypt that weird language the blue people used. This language, Na'vi, is essentially a cacophony of clicking, hissing, and everything else that us earthlings consider gibberish. Well, our health system can be equally as perplexing.
On principle, most people try to avoid confusing situations. A visit to the doctor can be a bewildering encounter in itself, and many people avoid seeking care for this simple reason. The most common complaints of confusion concern:
- Insurance billing
- Medical terminology
- Compliance regimens
- Conflicting or contradictory physician/specialist opinions
- Complicated technology and information systems
Put simply, the US healthcare system is a confusing jungle to navigate. Unless actions are taken to help make it easier to understand, people will continue abusing the system or neglecting care altogether.
I suppose I'm ending this post on a rather pessimistic note. I've described the 3 most common barriers to quality care, but I’ve not yet proposed any solutions. Here are three that we'll be touching on soon:
1. Improve Access
2. Reduce Costs
3. Improved Education and Awareness
To find out how employer-funded medical care and on-site medical clinics help remove these barriers, visit www.careatc.com or read more about how self-insurance might be a good first step.