Americans Face Barriers to Health Care Beyond Cost

Release Date: August 19, 2011 | By Katherine Kahn, Contributing Writer
Research Source: Health Services Research


  • A new study found that while cost concerns prevent 18 percent of Americans from getting needed health care, 21 percent delay health care for nonfinancial reasons.
  • Nonfinancial barriers to health care include getting to the doctor, getting a timely appointment and taking time out of other responsibilities.
  • Two-thirds of Americans who had trouble affording health care also experienced nonfinancial barriers to accessing medical services.
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IMPORTANT NOTICE: Health Services Research, the official journal of the AcademyHealth, has delayed release of the study until Monday, August 22.

Cost is only one barrier to getting timely medical care, a new study finds. Just getting to the doctor, making appointments and taking time off from work or other responsibilities are also major hindrances for some people to getting the medical care they need.

“In the minds of many people, they often equate affordability with access, when in reality there are all kinds of reasons why people can’t get the care that they need when they need it,” said lead author Jeffrey Kullgren, M.D., a primary care physician and a Robert Wood Johnson Foundation Clinical Scholar at the Philadelphia VA Medical Center and University of Pennsylvania. The study appears online in the journal Health Services Research.

Kullgren and colleagues looked at data from the 2007 Health Tracking Household Survey, which gathered health information from nearly 18,000 people across the United States.

The researchers found that nearly 19 percent of U.S. adults did not get needed medical care or delayed medical care because they were worried about the cost or their health insurance would not pay for treatment. However, even more people — 21 percent, or one in five adults — experienced nonfinancial barriers to getting the care they needed. In addition, financial barriers appear to go hand in hand with nonfinancial barriers for many people: two-thirds of those who had trouble affording care also reported experiencing nonfinancial barriers.

The most common nonfinancial reasons for not getting medical care were being too busy with work or other commitments, not being able to get to the doctor’s office when it was open, not being able to get an appointment soon enough and taking too long to get to the doctor’s office.

“This is important food for thought in terms of health care reform. It would be naive to think that health insurance is the only factor that affects access to care,” said Rachel Gold, Ph.D., a researcher at the Center for Health Research at Kaiser Permanente in Portland, Ore. She was not associated with the study.

As policymakers begin to implement the Patient Protection and Affordable Care Act, Kullgren said, “We need to think about how to organize the existing resources we have in ways that are going to improve access to care.”

For example, this might include offering evening and weekend outpatient health services, making it easier to get a timely appointment with a health care provider, increasing the use of email and telemedicine communications and providing incentives for providers to work in underserved areas.

“This study indicates a need for providing more federal support rather than less — so not just financially covering people’s care but making sure that the health care systems have enough support that they can provide care in a way that is actually meaningful,” Gold said.

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Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust.  For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or [email protected]. HSR is available online at

Kullgren JT, et al. Nonfinancial barriers and access to care for US adults. Health Serv Res online, 2011.

Tags for this article:
Health Care Access   Patient Engagement  

Comments on this article
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Thomas Randolph says
August 19, 2011 at 2:11 AM

There is a major morale issue within the medical profession and it deals with the loss of clinical autonomy.
Doctors are slowly becoming non-management employees who must follow a corporate set of rules.
Corporate earnings and health care budgets now dictates the treatment that should be rendered.
“Imagine going through medical school, residency and fellowship only to be told what to do by a non- medical administrator.
Health care providers are starting to look like factory workers on a large corporation assembly line-- Insurance companies are losing the balance between integrity and economics.

The same self serving corporate influences that drove this country into recession will further destroy health care. Corporate greed and their expansion strategies will eventually force private doctors into practicing