Accessing specialty healthcare can be difficult for many individuals in the United States due to several factors. One of the main barriers is the high cost of healthcare services, particularly for those without health insurance or limited coverage. Many specialty care services, such as surgeries or advanced diagnostic testing, can be prohibitively expensive, making them unattainable for those who need help to afford them. Even those with health insurance come across many barriers to accessing specialty care. A shortage of specialists in certain areas, particularly in rural or underserved communities, can lead to long appointment wait times or difficulty finding a specialist who accepts a patient’s insurance. Navigating the complex healthcare system can be challenging, particularly for those who need to speak English or are unfamiliar with obtaining referrals and authorizations.
These additional factors can make accessing specialty healthcare a significant challenge for many individuals:
1. Insurance Limitations
Many health insurance plans have limitations on which specialists are covered or require higher out-of-pocket costs for specialist care. This can make it difficult for some individuals to access the specialty care they need. In addition, if the patient has an HMO, a visit to your primary care practitioner is often required before seeing a specialist. If the patient arrives for a specialist’s appointment with no referral, they may be asked to:
- Contact the primary care physician to obtain the referral.
- Reschedule the appointment.
- Pay the estimated cost of the service before seeing the physician.
By having to take these additional steps, patient care is delayed.
2. Geographic Barriers
Some areas of the US need more specialists, particularly in rural or remote regions. This can make it difficult for some patients to access the necessary care. Geographic challenges can be as simple as the distance to and from the specialist’s office to receive care, or the challenges can be more complicated like not having a neurosurgeon in any surrounding cities and creating long-distance travel plans accommodations to access care. These issues are often referred to as social determinants of health (SDoH). Some patients in urban areas also face geographic barriers due to a lack of transportation or long travel times using public transit.
3. Wait Times
Long wait times can lead to delays in diagnosis and treatment, resulting in disease progression or complications. This can lead to poor health outcomes, reduced quality of life, and increased healthcare costs. Wait times can also disproportionately affect specific populations, such as those with low income, limited access to transportation, or who live in rural areas with fewer healthcare resources. Long wait times can cause significant stress and anxiety, further impacting an individual’s physical and mental health. Wait times for healthcare services can play an essential role in determining an individual’s overall health and well-being, making access to specialty care advice a critical social determinant of health.
Wait time data for Endocrinology and Gastroenterology:
- Endocrinology has an average wait period of 67 days, which surpasses the overall survey average by 19 days.
- Gastroenterology generally has more providers per clinic, yet still averages a 64-day wait time per provider and a 16-day increase from the overall average.