The Big Five: Limited Access to Healthcare


With the phenomenal increase and advancement in healthcare technologies over the past few decades, many would like to think technology has the power to fix many if not all of the problems facing healthcare; however, upon deeper inspection there are complicated problems impacting the activities outside the four walls of a healthcare organization. Outside those four walls are communities of patients that sometimes struggle just getting to the front door. Access to health care services in the U.S. continues to be a problem plaguing everyone from inner-city urban areas to remote rural areas. Some key challenges that we have found from research and customer feedback that contribute to this problem are:

  • Lack of patient transportation
  • No or limited health insurance
  • Language barriers

Lack of Patient Transportation

Patient transportation is a much bigger problem than most people outside the medical world realize. For those who can easily access public transportation or own and drive a car, patient transportation can be easily overlooked as a hurdle; however, those most likely to be making routine healthcare visits for chronic conditions are more likely to not have access to transportation due to injury, age, location of residency or other complications. One study of 593 Texas cancer patients revealed that poor access to a vehicle was a barrier for up to 60% of the group that could result in missing a treatment. The percentage varied by ethnicity, as many studies around transportation challenges do. Two separate studies found that 25% of patients missed an appointment due to transportation problems. Eighty-two (82) percent of patients that kept their appointments had access to a car and only 58% of patients that did not keep their appointments had access to a car.

This hurdle can severely affect the revenue cycle and flow for your healthcare organization. Cancellations equal lost revenue for your business, so don’t let this hurdle go untreated.


While there is no defined solution to this problem yet, the following areas can contribute positively to your organization:

  • Healthcare officials working closely with city and urban planners, considering transportation to community healthcare providers.
  • Scheduling medical appointments in conjunction with non-medical transport availability.
  • Expanding access to non-medical transportation.
  • Utilizing telemedicine to expand the reach of healthcare providers.

No or Limited Health Insurance

Any healthcare revenue cycle specialist knows that insurance is one of the keys to a healthy bottom line, so how do you stay healthy when you must take all patients, regardless of their insurance situation? The Affordable Care Act did help with producing an increase in insured patients. In 2014, following the adoption of the Act, only 33 million Americans were uninsured, or 10.4% of the U.S. population, down from 13.3% in 2013.

Lack of insurance has shown to contribute to negative health of patients. Uninsured people are:

  • Less likely to receive medical care;
  • More likely to die early;
  • More likely to have poor health status.

Uninsured are also costing our healthcare system. Hospitals pick up 60% of the burden of uncompensated care, with community based providers and office-based physicians providing the remainder. The National Bureau of Economic Research found that the demand for hospital care among the uninsured costs hospitals $900 per patient each year.


An Outreach and Enrollment Specialist can help patients navigate the complicated healthcare process, connecting uninsured patients with insurance and other programs to help pay for their needed healthcare services.


Language Barriers

Almost 60 million U.S. residents reported that they speak a language other than English at home in the 2010 Census, up 158% from the 2000 Census. Patients identified as Limited English Proficient (LEP) face a litany of barriers interacting with their healthcare providers, including:

  • Understanding medication instructions;
  • Understanding discharge instructions and medical education materials;
  • Understanding different appointment types;
  • Effectively communicating medical concerns to their healthcare provider(s).

A 2013 study found language as one of the top 5 barriers to health care access. In another study, there was no interpreter involved in 46% of emergency department cases involving patients with Limited English Proficiency. This language barrier doesn’t just cause negative clinical outcomes, but can result in physical harm. Patients with LEP are more likely to suffer physical harm when errors occur than English-speaking patients. One study revealed that 43% of hospitals identified a direct relationship between patient safety issues and patients’ linguistic needs.


The Agency for Healthcare Research and Quality (AHRQ) published a guide with five key recommendations to improve patient safety for LEP patients:

  • Foster a supportive culture for safety of diverse patient populations.
  • Adapt current systems to better identify errors among limited English proficient patients.
  • Improve reporting of medical errors for limited English proficient patients.
  • Routinely monitor patient safety for limited English proficient patients.
  • Address root causes to prevent medical errors among limited English proficient patients.

Have you dealt with any of these issues at your healthcare organization? Did you implement any of the above solutions or others that had a positive impact on your patient base and healthcare? Let us know in the comments below or email us at!