Healthcare access is not an issue only for patients. In a recent Medscape report, more than a third of doctors surveyed said access to quality, affordable healthcare had affected them or their families.
"Access affects even the highest earnings," noted one survey respondent, an ob/gyn.
And about half of respondents in the Physicians Rate Healthcare Access Report: Ongoing Problem for Patients chose healthcare access among their leading social issues, although they interpret the term differently. For example, one doctor commenting on the report insisted that healthcare is accessible to every American — but also conceded our system is inefficient and expensive.
Physicians' opinions about healthcare access differ somewhat based on age and region, and widely about underlying causes and potential solutions. But most agreed that affordability presents a major problem.
An Increasingly Expensive "Privilege"
Several physicians addressed the fundamental question of whether access to healthcare should be considered a right or a privilege.
"It seems for the elderly and the very poor, we make it a right. For everyone else, it's an ever-increasing-in-cost privilege," complained one respondent, a family medicine physician. "People shouldn't have to choose between losing their house and treating their cancer."
Many respondents pointed to high prescription drug costs as the main barrier.
"The largest problem in healthcare access at present is the unconscionable drug prices and lack of coverage for old, generic medicines," a gastroenterologist explained.
In a comment, a New Jersey pathologist said soaring prescription drug prices not only confront families with ugly choices but also can constrain effective care. "Why should a multiple sclerosis patient be forced to either foot a $100,000 bill or take a far less effective medication, only because it is less costly?" he said.
Paperwork and Prior Authorizations
Fortunately, many doctors are doing their part to help patients battle healthcare inflation. As the report notes, a number of respondents' practices offer payment alternatives such as hardship options, free treatment, or financial assistance for under- and uninsured patients.
Still, providing a GoodRx card only goes so far in helping patients manage high healthcare costs, physicians said.
"It is so complicated to get charity care that patients often don't manage to complete all the paperwork," explained one rheumatologist. "Even if medical expenses are covered, my patients can't afford gas and time off from work to get to appointments."
How much of a problem is the health insurance industry? "The insurance companies are the problem," a family medicine practitioner said. "Prior authorizations for medications that are FDA-approved should not need to be required in order for me to treat my patients."
Less Waste, More Portability
While many physicians lamented the issues with healthcare access, they often couldn't offer practical answers. "I lack the expertise to know with certainty what is the best system," one pathologist confessed.
Some respondents did come up with some proposed tweaks. "Healthcare access needs to be improved by getting rid of the middle management and wastage and redundancies," a psychiatrist said.
Meanwhile, one otolaryngologist respondent argued for insurance portability. "Patients need portable health insurance not tied to employment and should be able to deduct healthcare premiums from taxes just like businesses do. "
Other suggestions for improving access and affordability included expanding Medicare and/or Medicaid, adopting certain aspects of European healthcare models, and setting a "baseline option" of guaranteed coverage that could be supplemented with private insurance.
Patients' Own Responsibility
Physicians surveyed did not ignore patients' roles in their own healthcare.
"We need to strive to make healthcare accessible to all," said a family medicine doctor, "but everyone needs to be responsible for a part of their healthcare. Otherwise, there is not enough money around to pay for everything [that] everyone will want."
Some respondents insisted a patient co-pay is necessary, even with Medicaid, to help keep medical practices stay solvent and to serve as a disincentive to seeking too much high-cost care. "Patients need to have some skin in the game," one doctor said flatly.
Another major factor currently limiting access is a shortage of physicians — especially outside major population centers. "The line 'healthcare for all' is a farce," a rheumatologist explained. "There is a shortage of physicians, particularly in my specialty. Even more important, there is a severe maldistribution of physicians.
"Until the shortages are addressed, healthcare for all is illusory."
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Cite this: Physicians React: On Access to Quality, Affordable Healthcare - Medscape - Aug 27, 2022.