The delivery and execution of health care services over the past decade have faced drastic changes both for good and arguably in some ways for the bad. In many places globally the utilization of public health care is very minimal due to various factors. Phenomenons such as age, gender, disabilities, education and social/economic status all contribute to how much health services are utilized. In rural or mountainous locations, accessibility plays a vital role in how much of the services are actually used. Despite the improvements with health care accessibility disparities still remain primarily between urban and rural sectors. Nationwide there is a drastic increase in income inequality which also plays a significant role in the unequal distribution of public care. A prime example of this is China, with a population of roughly 1.37 billion people approximately 50% of those people are spread across rural and remote areas, which decreases their chances of exposure to health care services. The mortality rate in poorer rural areas is strikingly larger in comparison to urban areas. There is an abundance of financial burden due to the expenses of treatments, medications as well as transportation. The system has also been designed to have very limited reimbursement for health-related costs to those of lower economic status’.

Accessibility

Accessibility to health facilities and professionals in certain demographics is a leading factor in why there is an underutilization of health services. Hospitals are often located in larger urban areas, where people from rural areas can not easily have access to. Inadequate transportation is the most evident cause because in most rural areas public transportation is not readily available. In 2018, it was estimated that roughly 80% of women had major complications during childbirth due to not being hospitalized. Complications such as excessive bleeding, infections and high blood pressure were all prevalent symptoms in non institutional births with severe cases resulting in the death of the mother or child. Access to healthcare requires entry into facilities and communication with healthcare providers to ensure that the patient is able to fully utilize health care resources. There are more depths to it, in terms of connecting individuals with specialists, and allowing them to build trust with their physician. Accessibility has various magnitudes within itself including, approachability, acceptability, availability and accommodation. This model was developed by JF Levesque who created a plan to have health care access orientated around the patient. Accessibility does not just mean availability to a physical facility but also if individuals have access to health insurance and how available professionals are to accept the different kinds of insurances. Providers can not be able to give their service due to not having appointments available or are unable to accept the specific insurance type. Although physical access is there, various other factors aid in the underutilization of health care services globally.

Economic barriers

Access to health care is directly related to being able to afford the services. In the United States, in particular, financial barriers have drastically risen primarily with low-income households and uninsured individuals. A 2015 study assessed health services in developed countries with high incomes and had ranked the United States at the bottom of the list. It was also determined that roughly 25% of wealthy individuals who had high coverage insurance went without needing medical care. The economic barrier made it up to 5 times more difficult for uninsured individuals to get treatment or medication for their ailments. Despite having coverage it does not result in inadequate coverage, the majority of the insurance plans required individuals to go the cost- sharing route which was a huge financial burden. Due to the financial stress associated with medical care the majority of individuals opt-out and tend to neglect their health and avoid health services because they simply can not afford the care.

Race and Ethnicity

Racial biases and disparities are highly prevalent within the medical field. Black, Hispanic, Asian and Indigenous people have been stereotyped to be of lower socioeconomic ranks, amplifying the racism within health care. Those in disadvantaged areas are said to be visible minorities, and because of this are exposed to higher rates of chronic illnesses without proper access to treatments. Race and ethnicity disparities continue to play pivotal roles in health care due to the stigma ingrained through society and years of generational racism. Visible minorities are also often rejected from insurance plans or are only offered extremely high rates, which deters them away and increases the neglection of health. Many people of colour have also claimed they had to wait extended periods of time, were misdiagnosed and have negative experiences in health care facilities which further drove them away from accessing health care services. The Institute of Medicine conducted a study on Unequal Treatments and determined that Black people received less effective care in comparison to white people with the same health condition. Bias and prejudice in health care create a larger divide in health care equality. These three primary factors are just touching the surface of what factors contribute to the underutilization of health care services. Various things are taken into consideration that facilitate and hinder access to healthcare, such as transportation, demographics, insurance etc. The topic of accessibility leads to the evidently large economic barriers which are extremely detrimental and contribute heavily to disparities in the utilization of resources. Despite many individuals having full access to them, they simply can not afford the costs of basic treatments or medications. This creates a larger divide amongst economic classes but also deviates lower- income individuals from exercising their right to utilize healthcare. Lastly, race and ethnicity biases can be seen in the medical sector and due to general stereotypes minorities face discrepancies with their treatments and experiences in healthcare facilities. Implementation of generic and biases in modern society further enhanced the factors contributing to the underutilization of health services.

Works cited

Chen J, Vargas-Bustamante A, Mortensen K, Ortega AN. Racial and ethnic disparities in health
care access and utilization under the Affordable Care Act. Medical Care. 2016;54(2):140–146
Davis K, Ballreich J. Equitable access to care—how the United States ranks internationally. New
England Journal of Medicine. 2014;371(17):1567–1570
Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care
access in the rural USA. Public Health. 2015;129(6):611–620
Horwitz JR, Nichols A. Rural hospital ownership: Medical service provision, market mix, and
spillover effects. Health Services Research Journal. 2011;46(5):1452–1472
Kressin NR, Groeneveld PW. Race/ethnicity and overuse of care: A systematic review. The
Milbank Quarterly. 2015;93(1):112–138.
KFF (Kaiser Family Foundation). Key facts about the uninsured population. Menlo Park, CA:
The Henry J. Kaiser Family Foundation; 2016.
Levesque JF, Harris MF, Russell G. Patient-centered access to health care: Conceptualising
access at the interface of health systems and populations. International Journal for Equity in
Health. 2013;12(1):18.
NCHS (National Center for Health Statistics). Health care in America: Trends in utilization.
Hyattsville, MD: US Department of Health and Human Services; 2003.
NCHS. Health, United States, 2015: With special feature on racial and ethnic health disparities.
Hyattsville, MD: National Center for Health Statistics (US); 2016. Health, United States
Owens GM. Gender differences in health care expenditures, resource utilization, and quality of
care. Journal of Managed Care & Specialty Pharmacy. 2008;14(3 Suppl):2–6.