Study Finds Americans Experienced Increased Barriers to Health Care Over the Past 20 Years

A Yale study found that despite growing investments in health care over the past 20 years, barriers to timely medical care are increasing, as are racial and ethnic disparities in access to health care.

Using data from 1999 to 2018, investigators from the Yale Center for Outcomes Research and Evaluation (CORE) evaluated trends regarding five barriers to timely medical care: inability to get through by phone, no appointment availability, long waiting times, inconvenient office hours, and lack of transportation. The researchers found that the percentage of US adults reporting any of these barriers nearly doubled from 1999 to 2018, with 1 in 7 Americans experiencing these barriers by the end of the study period.

The study was published Oct. 28 in JAMA Health Forum.

“Importantly, there are disparities in these barriers, and they are getting worse,” said Dr. Cesar Caraballo-Cordovez, MD, a postdoctoral associate at Yale School of Medicine and the lead author of the study. “Black and Latino/Hispanic adults were more likely to experience barriers to timely medical care than White people in 2018. Black and Latino/Hispanic people were more likely to delay care due to long waiting times at the office and due to lack of transportation.”

The study has important implications for public health policy in the US, according to senior author Harlan M. Krumholz, MD, Harold H. Hines Jr. Professor of Medicine and director of CORE. “Despite health reforms and innovations by the private sector, our nation is losing ground on access to health care. People are facing greater barriers now than 20 years ago despite the trillions more dollars that have flowed into the health care system.”

“Moreover, Black and Latino/Hispanic people continue to have a greater disadvantage across a range of metrics of access. In this study we discussed barriers that are not directly related to cost of care, complementing our previous finding of worsening disparities in affordability of care during the same period. How is it possible that, compared with the turn of the century, people are having a harder time getting health care in recent years – and disparities have not only not improved, but have worsened. Our current approaches are failing to improve access.”

The study team included Chima D. Ndumele, Brita Roy, Yuan Lu, Jeph Herrin, all from Yale, and Carley Riley from the University of Cincinnati College of Medicine.