Living Without Access to Tertiary Care

Health disparities continue to be an area of concern for physicians, health policy experts, and federal health agencies. The reasons behind their existence are complex and involve many factors. One example of a health disparity is how different populations have more or less access to medical care, a phenomenon that has been validated across a number of different studies [1]. In particular, this article will discuss disparities in access to tertiary care. 

A looming barrier to health care for many in the U.S. is cost. A 2016 survey focused on 11 countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) revealed that adults in the U.S. are more likely than those in other countries to live without required care because of costs. They are also far more likely to struggle to afford basic necessities [2]. Fifteen percent of U.S. adults reportedly worried about having enough funds for nutritious food, and sixteen percent struggled to cover their rent or mortgage. A total of half of U.S. adults struggled to obtain health care on the weekends and evenings without being admitted to an emergency department, while fourteen percent of adults with chronic illness mentioned that they did not receive the support they needed to manage their conditions from health care providers. Despite progress since the passage of the Affordable Care Act, adults in the U.S. remain more likely to go without needed health care compared to adults in other high-income countries across the world. In the end, adults in the U.S. are more likely to report suffering from poor health and emotional distress.  

However, health care in the U.S. is associated with high rates of timely access to specialist care, effective access to discussions with health care providers about ways to lead a healthy life, and well-coordinated hospital discharge planning.  

If a patient is hospitalized and requires a higher level of specialty care, their doctor may refer them to tertiary care. Requiring highly specialized expertise and equipment, this tertiary care ensures procedures such as dialysis, plastic surgery, coronary artery bypass surgery, neurosurgery, treatment for severe burns, and other complex treatments or procedures. However, because of how specialized tertiary care is, it can be more difficult for patients to access, whether due to cost, location, or availability. 

A small, local hospital may not be able to provide these services, meaning that a patient requiring more advanced care may need to be transferred to a medical center that provides highly specialized tertiary level services.  

In addition, studies have demonstrated that a primary care provider should remain involved when a patient is in need of tertiary care for certain chronic conditions such as diabetes and chronic kidney disease since they can help establish and maintain a long-term patient management plan and access point 3. About ten percent of Americans, however, do not have health insurance [4], and individuals without insurance are less likely to have a primary care provider. These individuals may not be able to afford medications and health care services, and further may find it harder to get access to appropriate care without a primary care entry point [5]. In the U.S., many individuals as a result continue to live without access to tertiary care, or without the necessary supports required to gain effective access to tertiary care.  

A number of factors can influence a patient’s access to care. First, a 2010 study found a large disparity between rural and urban geographic access to tertiary healthcare. Strategies to enhance rural access need to be implemented in order to improve patient care access [6]. In general too, strategies to increase insurance coverage rates are critical for making sure more individuals gain access to important health care services like preventive care and treatment for chronic illnesses. 

Finally, most recently, a global health program incorporating social work, patient navigation, referrals, and direct financial and non-financial support, was revealed to be a successful model to increase access to specialty care by both increasing referral acceptance and appointment attendance [7]. This model may inspire strategies to boost tertiary care access across a variety of geographical settings.  

References 

1. Riley, W. J. Health disparities: gaps in access, quality and affordability of medical care. Trans. Am. Clin. Climatol. Assoc. (2012).
2. U.S. Health System Will Need to Adapt to Climate Change. Available at: https://www.commonwealthfund.org/blog/2018/be-high-performing-us-health-system-will-need-adapt-climate-change. (Accessed: 13th November 2021)
3. Lo, C. et al. Primary and tertiary health professionals’ views on the health-care of patients with co-morbid diabetes and chronic kidney disease – A qualitative study. BMC Nephrol. 17, 1–12 (2016).
4. Berchick, E. R., Hood, E. & Barnett, J. C. Health Insurance Coverage in the United States: 2017 Current Population Reports. (2018).
5. Health Care Access and Quality – Healthy People 2030 | health.gov. Available at: https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality#cit1. (Accessed: 24th February 2023)
6. Beedasy, J. Rural Designations and Geographic Access to Tertiary Healthcare in Idaho. doi:10.4148/ojrrp.v5i2.191
7. Burlotos, A. et al. Impact of a Novel Social Work Program on Access to Tertiary Care. Ann. Glob. Heal. 88, (2022). doi: 10.5334/aogh.3585