Understanding the Difference between Health Insurance and Access to Healthcare
Health insurance is important in the United States since it can help provide people with the coverage they need for medical services. However, there’s a difference between having health insurance and having access to healthcare.
By: Deborah Palmer
Health insurance is only half of the equation when it comes to accessing healthcare. Many people, even those with health insurance, struggle to access the healthcare services they need. While having health insurance is necessary for most Americans, it won’t guarantee immediate access to healthcare. In fact, there are many factors that can impact a person’s ability to receive necessary care. Depending on the insurance plan, patients may be subject to high deductibles, limited coverage, and other restrictions that could make accessing care difficult. Even those with comprehensive health insurance may have trouble getting an appointment with a primary care provider or a specialist due to long wait times, especially if they live in more rural areas.
1. What is Health Insurance? Health insurance is a form of insurance that helps to cover the cost of medical and surgical expenses. It is a way for individuals to protect themselves from the financial burden that comes with unexpected health issues. Health insurance can be purchased through an employer or privately and can cover a range of healthcare services, such as doctor visits, hospital stays, and prescription medication. While health insurance is often a necessity in our society, it does not automatically ensure quality healthcare.
2. What is Access to Healthcare? Access to healthcare refers to a person’s ability to obtain medical attention when they need it. This includes physical accessibility to medical services, financial affordability of healthcare, and overcoming social, cultural and linguistic barriers. A lack of access to healthcare can result in delayed or inadequate treatment which can worsen a person’s health or lead to more severe medical conditions. It is important to note that access to healthcare can exist independent of health insurance.
3. How Does Health Insurance Impact Access to Healthcare? While health insurance can be a valuable tool in obtaining healthcare services, it does not guarantee access. For example, high out-of-pocket costs such as copays, deductibles, and coinsurance can make healthcare unaffordable for some individuals, even if they have insurance. Additionally, some insurance plans have restrictions on the types of healthcare services they cover or limit the number of visits a person can make to a healthcare provider. Some health insurance plans (notably HMO plans) require referral from an in-network PCP in a time where PCPs are already in short supply. These limitations create barriers to accessing healthcare even for those with health insurance.
4. What Can be Done to Improve Access to Healthcare? It is crucial to recognize the impact that access to healthcare has on a person’s overall health and wellbeing. Steps can be taken to improve access to healthcare such as improving affordability, increasing the number of primary care physicians available, implementing preventative programs to reduce healthcare disparities. Advocacy and policy changes can also have a significant impact on improving access to healthcare for those who are currently underserved.
Another option is that of “Direct Primary Care”, an alternative practice model that’s removes insurance from the equation, allowing for access to care that is more personalized and at a reasonable upfront price. With direct primary care, patients pay a flat monthly fee for their care and direct access to their doctor when they need them. Services include routine checkups, chronic disease management. Direct primary care providers work to build a strong relationship with each patient, which allows them to provide more customized care.
The accessibility and availability of healthcare services is another major benefit of direct primary care. Because direct primary care providers have fewer patients and don't have to deal with the complexities of insurance billing, they’re able to offer same-day or next-day appointments and extend their hours beyond regular business hours. This makes it easier for patients to get the care they need when they need it, without having to wait days or weeks for an appointment.
Direct primary care also can help patients save money on healthcare costs. Since direct primary care providers charge a flat monthly fee, patients don’t have to worry about the high deductibles and copays associated with traditional insurance plans. Additionally, direct primary care providers are able to spend more time with each patient, which means that they can offer more personalized care and help prevent health problems before they become serious.
While health insurance is important for financial security in the event of unexpected medical issues, it is not the same as access to healthcare. Having health insurance does not necessarily guarantee that a person will be able to obtain the medical attention they need. In order to address health disparities and improve health outcomes, it is crucial to focus on both health insurance and access to healthcare, we can work towards a more equitable and just healthcare system for all. If you’re looking for a more accessible and affordable way to manage your health, direct primary care is definitely worth considering.
Looking to learn more, reach out to Freedom Doctors or schedule a Meet & Greet Zoom visit to see how you can benefit from Direct Primary Care.
Other topics you’re interested in hearing about send us an email. Contact Us.