Barriers to Preventive Care and How We Can Overcome Them
By Dr. Harold Delasalas, MD on August 24, 2022
The U.S. health care system, for a long time, has focused on treating those who are ill. Less effort has historically been put into helping people avoid those illnesses.
According to the Centers for Disease Control (CDC), seven out of 10 U.S. deaths are caused by chronic disease, while roughly half of the country's population has been diagnosed with a chronic illness, including heart disease, cancer, diabetes, AIDS, or other conditions classified by the medical community as preventable. We also know preventive care services could save over 10,000 lives in the U.S. every year. But it can be hard to convince many people to take the time, and prior to the Affordable Care Act, the money, to go to the doctor when they feel totally healthy. Many organizations are working on removing barriers to preventive care and highlighting why this type of care is so important.
Examples of Preventive Care
Preventative services are routine health screenings and checkups to prevent illnesses, disease, or other health problems. This includes:
Blood pressure, diabetes, cholesterol tests, allergy testing
Many cancer screenings, including mammograms and colonoscopies
Well-baby and well-child visits
Counseling on topics such as quitting smoking, losing weight, eating healthy, treating depression, reducing alcohol use
Routine vaccinations against diseases such as measles, polio, meningitis, flu and COVID-19
Tobacco use screening
Removing Barriers to Preventive Care
The goal of preventative health is to reduce morbidity/disease burden in the individual and the population. The premise is that preventative health is less expensive and has far reaching benefits to avoid complications that develop because of failing to diagnose and control an underlying condition. For example, poorly controlled blood pressure can place a patient at risk for a stroke, a heart attack, and kidney damage/failure.
A major impediment often discussed is cost- there has been mixed criticism regarding the Affordable Care Act in 2010, but from the patient and physician’s perspective, it’s been useful to improve access to care, reduce rising medical costs, and thus improve health outcomes. One of the vehicles for ensuring this was to ensure preventative services would be at no cost to the patient. Many individuals have transitioned to contractor roles, leaving behind W2 benefits including health insurance. For those with health insurance, a popular plan has been the “high deductible plan” which affords preventative services, by waiving the deductible but charging a copay. For those employed, preventative visits may sometimes be perceived as an “annoyance” and “inconvenient”. If I make this visit, I will have to make room in a tight schedule for a visit that someone takes some vital signs, draws some blood work, and counsels me? Beyond this of course are those who are not currently employed and have savings adequate only to pay for emergency/urgent care visits.
Some strategies to help with this model include incorporating telehealth services to help reduce inconvenience for individuals. Some employers have also developed office health hubs that make appointments easier for their workers versus having to lose productivity to accommodate travel.
A recent study showed only 8 percent of adults were getting all the highly recommended preventive services with the greatest potential for improving health. On the bright side, 20 percent of adults reported receiving more than 75 percent of the recommended services, which shows improvement and willingness to receive the recommended care.
Certain barriers need to be removed and improved to increase the number of people receiving all the recommended services.
Barrier = Cost
One large barrier to receiving care has always been cost. The Affordable Care Act aimed to remove the cost barrier to such services by requiring private insurance companies to cover basic preventative care. However, those who do not have private insurance still have to pay to receive these services.
Barrier = Access
Many people live in care deserts or far from clinics and hospitals. The time and effort to go receive care is a big barrier.
Additionally, there are less primary care providers and more advanced practice providers with less training and experience in managing patients with complex medical conditions. One pattern we’ve seen with this is a hub and spoke model to preventative medicine wherein folks are referred to specialists to manage conditions often an experienced primary care provider and patients are seeing specialists less frequently about chronic conditions.,
Many communities are trying to close this gap by hosting free health fairs that provide general information about good health and preventative medicine, offer screenings and assessments on site, and back to school sports physicals for children. These fairs often happen in local communities, at parks and convenient locations for people to access them easily.
These health fairs are only the first step. Once an individual is found to have abnormal screenings tests (cholesterol, glucose, and/or blood pressure), they will need to receive counseling, follow-up to determine if lifestyle changes are adequate or medications are needed to treat underlying condition and prevent complications.
Barrier = Lack of Awareness
Many people are simply unaware of the importance of preventive care. Healthy People is a program of a nationwide health-promotion and disease-prevention goals set by the United States Department of Health and Human Services. They set data-driven national objectives to improve health and well-being and they help people access the recommended services.
Barrier = Lack of Funding
Public health agencies and organizations exist on both federal and state levels. However, these are continually underfunded, making it difficult to meet goals and fully provide the necessary resources for preventive care accessibility.
This is the irony that with potential savings that stem from preventative care, this remains the underfunded arm of healthcare. It’s unclear why this occurs, perhaps since implementation strategies often vary and the challenges in evaluating efficacy given suboptimal compliance.
Why Should You Care?
Preventive care saves lives. Vaccines save the lives of roughly 42,000 children on an annual basis. Preventive health screenings and primary care consultations have also been found to significantly increase life expectancy, particularly among the 30- to 49-year age group.
Preventive care saves you money and increases your quality of life. On a large scale, According to the CDC, chronic diseases that are avoidable through preventive care services account for 75 percent of the nation's healthcare spending and lower economic output in the US by $260 billion dollars a year. On an individual level, preventive screenings are covered by insurance, so these tests won't cost you money. Finding out about an illness or health issue through these screenings could increase your life expectancy and even save you your life. On a monetary level discovering an illness early could save you from having to spend on major surgery, medications or more serious medical intervention.
Focusing on preventive care and removing the barriers to access them is a priority for us at Nomi Health. Our Mobile Health Clinic frequents care deserts, we host free health fairs in communities that need easier access to care, and we provide vaccination clinics across the country. We know preventive care improves and saves lives and we work to find better solutions and responses to current blockers so more people can have access to the care they deserve.