Barriers to Healthcare in the

United States
Rachel Gerton
A Brief History of Healthcare
1800s

● “Healthcare” through unions

1930s

● Great Depression: “old age” benefits, unemployed, and disabled

1940s

● Foundation of employer-sponsored health insurance

1960s

● Social Security Act of 1965 (Medicare and Medicaid)

2010

● Affordable Care Act

What is a barrier to healthcare?

Any obstacle that prevents or challenges access to

● Gaining entry into the healthcare system

● Accessing a location
● Finding a reliable provider
Types of Barriers
Financial

● Insurance

Structural

● Healthcare system availability

○ Proximity, transportation, childcare, structural access

Cognitive

● Patient-provider relationship, health literacy,

cultural barriers
Root Causes - Financial
Health Insurance

● Any program that helps pay for medical expenses, whether through privately purchased
insurance, social insurance, or a social welfare program funded by the government.
● Uninsured vs. Underinsured

Affordable Care Act

● Most extensive expansion of coverage since Medicare & Medicaid in 1965

● “Expand access to insurance, increase consumer protections, emphasize prevention and
wellness, improve quality and system performance, expand healthcare workforce, and curb
rising health care costs”
Root Causes - Financial
Root Causes - Financial
Root Causes - Structural
Availability and Access

● Proximity
● Transportation
● Childcare
● Structural access
● Lack of funding
● “Brain Drain” (rural)
Root Causes - Cognitive
Healthcare Stereotype Threat (& Personal Biases)

● “More than 17% of the respondents said they felt vulnerable to prejudice with regard to
racial or ethnic identity, gender, SES, weight, or age in health care settings. People who felt
threatened based on several identities were worse off, health-wise, than people who felt
threatened based on just one identity”

Health Literacy

● Linguistic and Cultural Barrier

● Lack of funding (translators) and patient-provider communication
Impact
Health Disparities vs. Healthcare Disparities

● Health Disparities: higher burden of illness, injury, disability, or mortality

experienced by one population group relative to another

● Healthcare Disparities: refers to differences between groups in health insurance

coverage, access to and use of care, and quality of care
Impact - Health Disparities
● HIV/AIDS: disproportionately affects racial and ethnic minorities
● Cardiovascular Disease: racial and ethnic minorities, low SES

https://www.kff.org/report-section/key-facts-on-health-and-health-care-by-race-and-
ethnicity-section-3-health-status-and-outcomes/

● “The researchers found those people were more likely to have hypertension, to be
depressed and to rate their own health more poorly. They were also more
distrustful of their doctors, felt dissatisfied with their care and were less likely to
use highly accessible preventative care, including the flu vaccine”
Impact - Healthcare Disparities

Frequency of Care

● None or delayed

Quality of Care

● Lacking
Responses
Legislation - Early 2000s

● Studies revealed disparities in tobacco use and access to mental health resources
by race and ethnicity
● Minority Health and Health Disparities Research and Education Act of 2000 - to
measure progress on reduction of disparities
● Disparities Action Plan (Office of Minority Health): policy efforts to advance
health equity, expand access and quality, strengthen healthcare infrastructure and
workforce
● Culturally and Linguistically Appropriate Services (2013) - seeks to ensure care
that is culturally and linguistically appropriate
Responses
Availability & Access

● Policy (insurance, hospital funding, etc.)

● Raising Awareness/Community Organizing

Education

● Stereotypes
● Biases
Bibliography
https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

https://muse-jhu-edu.flagship.luc.edu/article/430672/pdf

https://www.kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-
five-key-questions-and-answers/

http://www.theadvocatesforhumanrights.org/uploads/rights_to_health_in_the_u_s_quiz
_2011_2.pdf

https://news.virginia.edu/content/study-links-disparities-pain-management-racial-bias