Access to healthcare is essential for promoting health and well-being, yet numerous barriers hinder an individual’s ability to obtain timely and effective healthcare services. Understanding perceived barriers to healthcare by physicians is important, as it sheds light on factors that influence a patient’s access to care and health outcomes. In oral interviews provided by the Southern Oral History Program and research studies, various challenges have been highlighted, including issues such as lack of transportation, dietary habits, inadequate education, and more. Some of these barriers were those experienced by physicians during their time as patients, while other barriers were identified during their time as physicians. A comprehensive comprehension of the underlying origins of these barriers is imperative for facilitating meaningful improvement in healthcare access and outcomes.
In the interviews conducted by the Southern Oral History Program (SOHP), George Cosmos, an obstetrician-gynecologist, provided valuable insights into the challenges individuals face in accessing healthcare. Growing up in rural North Carolina, George Cosmos details how due to the lack of healthcare insurance, his mother used to budget money just for healthcare visits outside of traditional checkups and immunizations. Oftentimes when funds were low, his mother relied on home remedies such as using aloe vera gel to treat cuts and burns and using turmeric to treat sprained ankles. Financial barriers were not only present in rural areas but in towns too 1. In another interview on the SOHP, Dick Merwarth, a former internal medicine doctor in the Raleigh area, discusses financial barriers to healthcare in the lower-income socioeconomic classes:
I had a clinic once a month, I think, for patients with respiratory illnesses, and what I saw—and this applied to a population of poor people, black or white, but given the demographics, more of the people that came to my clinic were probably black because they were poor, and if they needed a medication or needed a hospital bed, then it was often a real problem to find a hospital that had a bed dedicated to non-paying patients, who would accept this patient, or trying to find the money to buy a needed drug. It was probably a generic problem for all poor people… but that’s the sort of thing that would occur in people who didn’t have the finances to pay for their medical care. 2
Dick Merwarth used to run a public clinic frequently visited by lower-income individuals because it costs a lot of money to go to a private hospital. For example, Atrium Health charges $3,546 for a Rehab Bed currently, which was roughly $300 in the 1950s and 60s 3. The cost of healthcare, especially without health insurance, is absurdly high and poses a barrier to healthcare for people in poverty. A study by Christopher Mansfield and Lloyd Novick found that 46% of people making below $15,000 and 31% of people making between $15,000 and $25,000 reported having “fair or poor health”, compared to just 10% of people making between $50,000 and $75,000 and 5% of people making over $75,000 reporting having “fair or poor health” 4. This disparity highlights how having a lower socioeconomic status seems to be correlated with reporting fair or poor health.
Not only do patients in rural areas oftentimes lack financial resources for healthcare, but they also lack healthcare resources themselves, such as inadequate clinic timings, hospitals in distant, and even hospital beds. George Cosmos describes how Warren County has government-operated visiting stations where visiting doctors would have public and private hours. For most of the day, the doctors would have public hours, which is where anyone can visit without an appointment. For the last few hours, the clinic would be private, meaning only those with appointments would be seen at an extra fee. Additionally, George Cosmos recounts how many of his peers in his county would often face difficulties in traveling to clinics due to their distance and scarcity. According to Coombs et al., in the U.S., “there are fewer physicians and hospital beds per capita compared to most comparable countries… Rural areas, in particular, are subject to resource limitations”. Coombs et al. conducted a qualitative study where they questioned healthcare providers in rural areas about healthcare resource capacity. They found that many of the physicians in the study did not have adequate time for patient intakes, critical assessments, etc. due to a shortage of staff 5. Furthermore, the description of having additional time to spend with patients as a “luxury” exacerbates the limited resources available for patients in rural areas.
George Cosmos’ experiences as an obstetrician-gynecologist illuminate how health literacy deficiencies serve as a barrier to healthcare access and quality. In his discussion with the interviewer, Cosmos addresses the prevalence of unhealthy dietary habits, notably the reliance on fast-food options. By advocating for the cultivation of organic food to mitigate exposure to harmful chemicals and toxins, Cosmos implicitly acknowledges the lack of awareness surrounding nutrition’s pivotal role in overall health. Furthermore, his emphasis on the importance of regular exercise to combat sedentary lifestyles underscores the need for individuals to possess adequate health literacy to make informed lifestyle choices. These insights underscore how limited health literacy impedes individuals’ ability to adopt preventive health behaviors, ultimately serving as a barrier to preventive healthcare. Fortunately, this problem can be solved through lifestyle education. As described by Denise Hunter, an Internist at Caswell Family Medical Center and a specialist in lifestyle medicine, lifestyle education is the “focus on using evidence-based lifestyle practices, teaching people about diet and exercise and how interpersonal relationships and stress and sleep, and how all those things can affect your health and how you can improve those to improve your health”. Denise Hunter encourages taking on preventive care, emphasizing the importance of developing solid health habits to prevent diseases rather than relying solely on reactionary medical treatments 6. This includes eating healthy and nutritious food, following a proper sleep schedule, exercising frequently, and maintaining positive interpersonal connections.
George Cosmos’ interview along with the other interviews shed light from a healthcare provider’s perspective on the multifaceted barriers that impede individuals’ access to healthcare and compromise health outcomes. From financial constraints to inadequate healthcare resources in rural areas, these barriers show the systemic challenges inherent in the healthcare system. Also, the intersection of health literacy deficiencies with lifestyle choices further aggravates these challenges, hindering individuals’ ability to make informed decisions about their health and engage in preventive care practices. However, amidst these challenges lies an opportunity for intervention through comprehensive lifestyle education initiatives. By equipping individuals with the knowledge and skills to make healthier choices and prioritize preventive care, we can empower communities to overcome barriers to healthcare access and improve overall health and well-being.
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Footnote
- Scott, Darius, and George Cosmos. “Y-0015 Interview with George Cosmos.” Southern Oral History Program, Accessed 26 Apr. 2024.
- Allen, Nick, and Dick Merwarth. “Y-0074 Interview with Dick Merwarth.” Southern Oral History Program, https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28289/rec/125. Accessed 26 Apr. 2024.
- “Atrium Medical Center Average Charges.” 1 Jan. 2023. https://www.premierhealth.com/docs/default-source/default-document-library/atrium-average-charges64043750087c4c2f88874ac5f0811ffd.pdf?sfvrsn=2bfab757_23
- Mansfield, Christopher, and Lloyd F Novick. “Poverty and health: focus on North Carolina.” North Carolina medical journal vol. 73,5 (2012): 366-73.
- Coombs, N.C., Campbell, D.G. & Caringi, J. A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res 22, 438 (2022). https://doi.org/10.1186/s12913-022-07829-2
- Dixon, Ina, and Denise Hunter. “Y-0103 Interview with Denise Hunter.” Southern Oral History Program, https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28491/rec/128. Accessed 26 Apr. 2024.