Worldwide developments in the areas of epidemiology, demographics, and socioeconomic changes, such as urbanization, globalization, and reductions in mortality and morbidity rates, have led to chronic disease prevalence, thus undermining the strategies put in place for health improvement. To address this challenge, access to preventive measures for the population has become highly important to be introduced in many countries due to the findings that such services can improve health management at early stages of disease development (Rotarou & Sakellariou, 2018). Moreover, preventive care can contribute to the prevention and reduction of the subsequent total demand for medical care services. However, the access to preventative measures for some populations remains a challenge, especially among lower-income citizens, which leads to negative outcomes of health and increased costs of medical intervention when conditions exacerbate.
Historical Evaluation of the Challenge
The concept of preventive services is not new, and prior to the twentieth-century biomedical revolution, crucial advancements have been made toward the understanding and prevention of diseases. Three critical areas can be identified regarding the historical efforts of preventing diseases, such as the individual control over personal health by adhering to the recommended dietary and hygiene recommendations, social control over population health through isolating diseases and protecting people from environmental dangers, and the application of increased scientific understanding of diseases (Becker, 1988). As wealth inequality has existed for centuries, the history of unequal access to medical care illustrates that the social class differences in health status were consistent in Europe, Britain, and the US (Gibbons, 2005). According to the 1984 report “Health, United States, 1983” prepared by the US Department of Health and Human Services, even though the overall national health showed significant progress at that time, major disparities existed in “the burden of death and illness experienced by blacks and other minority Americans as compared with the nation’s population as a whole” (Gibbons, 2005, p. 50). Because racial minorities were also disadvantaged in terms of income, education, and work opportunities, it becomes clear that social determinants of health have influenced limited access to preventive services for a long time, and they remain to be addressed.
Increasing the access of populations to preventive care services remains a challenge for the US population despite the recommendations of healthcare professionals to engage in regular screenings for prevention and health management. As found by the Reuters Health report that collected data from around 2,800 adults aged 35 and older, only 8% of the surveyed individuals were getting the highly-recommended preventing services to facilitate health improvement and disease prevention (Lehman, 2018). Some of the commonly-mentioned reasons for not getting the suggested preventive services included the lack of health insurance, the absence of a regular doctor or nurse, as well as issues with the delivery of healthcare services, such as long wait times for appointments at clinics (Lehman, 2018). Moreover, social determinants of health, such as income, level of education, access to transportation, geographic location, and race, have resulted in a large number of health disparities. This means that individuals subjected to specific social determinants of health have shown to be less likely to access preventive care (Heath, 2020). Therefore, there is a range of factors that help define the limited access to preventive care services as a challenge affecting many population groups, especially those who are at a disadvantage in society.
Thus, preventive care access and utilization is determined by socioeconomic characteristics of populations, whose consequences of health depend on whether they have received care for the conditions they need treating. New technologies introduced to the healthcare industry, ranging from advanced drugs and vaccines to combination chemotherapy for many cancer types, have made healthcare more comprehensive, decreasing lengths of hospitalizations and improving overall population health (Heath, 2020). However, despite the introduction of enhanced services, there is no guarantee that all of them are equally available to all Americans. For instance, white women have higher likelihoods of having outpatient surgery compared to women of other ethnicities and races (National Academies of Sciences, Engineering, and Medicine, 2018). Medicaid beneficiaries who are poor and disabled have higher chances of using emergency care compared to populations with other coverage, in part due to their limited access to ambulatory care (Allen et al., 2021). Therefore, despite Medicaid coverage, there is impaired access to outpatient care for lower-income consumers.
In theory, the utilization of healthcare is expected to correlate highly with the need for medical services. However, some services are needed but are not obtained, while others are utilized but are not clearly indicated or are indicated only after the following of some protocols (Luy et al., 2017). Moreover, there is a lack of acknowledgment among policymakers as to how the disparities can be addressed. For instance, telehealth is still not used widely throughout the US, with the medical field continuing to determine how to use it more effectively.
Factors Reducing the Challenge
The reduction of barriers that prevent populations from having equal access to preventive services should be identified as a strategic priority. As a means for addressing the challenge of the disparities in access to preventive health care services, it is recommended that public health integrates considerations for health equity into policies and programs. It is also essential to collaborate with other sectors, such as social and economic, to address inequities while also engage with communities in supporting their work (Baciu, 2017). Besides, it is necessary to strengthen knowledge development and its transmission regarding issues of health equity.
There are multiple ways in which the US can achieved improved access to preventive services, especially when it comes to underserved groups. Starting at the stage of small-scale programs and initiatives, it is possible to focus either specifically on social determinants of health or target them with the help of more traditional health promotion or disease prevention projects (CDC, 2008). Also, traditional public health programs and initiatives can be implemented by being embedded into organizational structures that serve populations, such as the Boston Public Health Commission’s efforts to undo racism within the city’s communities and health care centers (CDC, 2008). Finally, large-scale programs directed specifically at addressing poverty, unhealthy physical environments, and racism must be implemented. An example of this is the Delta Health Center’s efforts to develop healthcare centers providing healthcare services by changing social determinants of health by helping communities organize and articulate their needs (CDC, 2008). Combining all three levels of policies can offer a multi-dimensional approach toward improving access to preventive care.
The current move of the US toward the Medicare For All initiative is concerned with developing a new healthcare system under which all populations of the country receive medical care through the federal government. In contrast to the current Medicare program, intended to serve individuals aged 65 and older, the updated program is expected to cover everyone living in the US, paying for all medically necessary services ranging from prescription drugs to dental care (Katch & van de Water, 2020). For long-term care, there will be additional out-of-pocket costs, while the limit for prescription drug payments would be $200 (Katch & van de Water, 2020). Even though the policy has the potential to reduce the gaps in access to preventive care, there is a risk of people not being accountable to their health, healthcare providers being less incentivized to provide care if they are not paid well enough, while preventive and elective procedures will be limited by long wait times. Thus, as of today, there is no effective policy or program that would help address the limitations to access to preventive services.
Summary and Conclusion
To conclude, preventive healthcare services are essential to maintaining good population health. Without adequate access of the population to such services, especially for the affected communities, as related to social determinants of health, the healthcare industry is challenged by addressing emergency cases as well as inadequate adherence to treatment. It is essential to implement structural and multi-level solutions aimed at reducing the adverse impact of socioeconomic factors while also considering the need for universal healthcare under the Medicare for All initiative. Nevertheless, access to preventive care remains a challenge to be addressed as there is a lack of consistency on the part of the government to challenge the existing systems that favor inequality.
Allen, H., Gordon, S., Lee, D., Bhanja, A., & Sommers, B. (2021). Comparison of utilization, costs, and quality of Medicaid vs subsidized private health insurance for low-income adults. JAMA Network Open, 4(1), e2032669.
Baciu, A. (2017). Partners in promoting health equity in communities. Web.
Becker, D. (1988) History of preventive medicine. In Becker D.M., Gardner L.B. (eds) Prevention in clinical practice. Springer. Web.
CDC. (2008). Promoting health equity a resource to help communities address social determinants of health. Web.
Gibbons M. C. (2005). A historical overview of health disparities and the potential of eHealth solutions. Journal of Medical Internet Research, 7(5), e50. Web.
Heath, S. (2020). Preventive care access, health disparities require second look. Web.
Katch, H., & van de Water, P. (2020). Medicaid and Medicare enrollees need dental, vision, and hearing benefits. Web.
Lehman, S. (2018). Most Americans miss out on preventive healthcare. Reuters. Web.
Lyu, H., Xu, T., Brotman, D., Mayer-Blackwell, B., Cooper, M., Daniel, M., Wick, E. C., Saini, V., Brownlee, S., & Makary, M. A. (2017). Overtreatment in the United States. PloS ONE, 12(9), e0181970. Web.
National Academies of Sciences, Engineering, and Medicine. (2018). Factors that affect health-care utilization. Web.
Rotarou, E., & Sakellariou, D. (2018). Determinants of utilisation rates of preventive health services: evidence from Chile. BMC Public Health, 18(839). Web.