June 30, 2020

Addressing social determinants of health - the circumstances in which people are born and live - is a business and moral imperative.

Full Series icon_right_chevron_dark

According to research, “access to comprehensive, quality health care services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity.”¹ Many people with employer-sponsored health care coverage, face barriers to accessing needed health services for the following reasons:¹

Lack of or inadequate health insurance;
High cost of care;
Inconvenient or unreliable transportation;
Physician shortages; and
Limited availability of health care services due to their geographic location.

In some countries, access is also affected by whether a person receives coverage through the private or public health system. These barriers can lead to unmet health needs, delays in receiving appropriate care, the inability to get preventive services, financial burdens and preventable hospitalizations.¹

Although many of your employees may have health insurance, it’s important to note that coverage does not remove every barrier to care. Studies show that even when people have coverage, the cost of health care services and medications influences their decisions about whether to obtain care. In 2018, about half of individuals with employer-sponsored insurance in the U.S. said that they or a family member skipped or postponed getting health care or prescription drugs in the past 12 months because of cost.² This happens even more among employees with higher deductibles; 6 in 10 of those with a deductible of at least $1,500 for an individual or $3,000 for a family say they skipped or postponed care.²

Among adults with employer-sponsored health insurance, in 2018, 28% were underinsured. Underinsurance “refers to adults who were insured all year but experienced one of the following:⁶

Out-of-pocket costs, excluding premiums, equaled 10% or more of income;
Out-of-pocket costs, excluding premiums, equaled 5% or more of income if low income (<200% of poverty); or
Deductibles equaled 5% or more of income.
Outside of the U.S., employer-sponsored health plans help pay for services not typically covered by a country’s national health plan, like dental and vision care.⁷ Although it provides quicker access to elective care and private providers, some people still experience high out-of-pocket costs for care.⁷

Additionally, where employees live can affect access to primary care doctors and specialists – including mental health providers – as many people living in rural areas experience difficulties receiving timely care due to physician shortages and greater distances to health care facilities.^1,3

Access to health care due to location and physician shortages is a particular concern for some underdeveloped countries and in rural areas of developed ones. In Nigeria, for example, only about 20% of government primary health care facilities are fully functional, and there is a scarcity of experienced doctors in the public system.⁴ And in India, bottlenecks in accessing health care services in the public sector cause some households to seek private care, which results in high out-of-pocket costs.⁵ Even when private insurance is available to employees, they may still not be able to access needed care because of strained health care systems.

Beyond these barriers, inconvenient or unreliable transportation can interfere with consistent access to health care. This topic is discussed in greater detail in the transportation section.

Ideas for Action

Employers can improve access to health care by assessing the affordability of health coverage for employees and implementing strategies to mitigate financial barriers to care. Additionally, employers can enact strategies to help employees without reliable transportation get to appointments, as well as ensure that employees and their families living in rural and underdeveloped communities have convenient sources of care. Specific solutions include:

Offering health care coverage to the entire workforce, including part-time employees;
Tiering premiums, account contributions and/or deductibles based on salary in order to promote equity across the employee population;
Re-introducing choice to your health plan offerings by including options with lower deductibles and coinsurance;
Providing expanded services in on- or near-site clinics, including primary care, mental health services and other specialty care;

Making available affordable telehealth solutions that offer a range of services, from acute care to mental health;
Including providers that accept Medicaid or CHIP in your on- or near-site clinics so that low-income employees and their families can access these convenient sources of care;
Covering the costs of travel and lodging for employees and their families utilizing Centers of Excellence;
Developing a core minimum benefits philosophy, so that employees have access to the same core services, regardless of their worksite location and local health policies; and
Implementing a captive to provide coverage for services that the local insurance market does not typically offer.

1 | Healthy People 2020. Access to health services. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services. Accessed February 15, 2020.
2 | Kaiser Family Foundation. Data note: Americans’ challenges with health care costs. 2019. Available at: https://www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/. Accessed February 18, 2020.
3 | AAMC. Health disparities affect millions in rural U.S. communities. 2017. Available at: https://www.aamc.org/news-insights/health-disparities-affect-millions-rural-us-communities. Accessed February 15, 2020.
4 | Health Landscape in Nigeria and West Africa. Presentation to the Global Business Group on Health’s December Forum. December 5, 2019.
5 | The Commonwealth Fund. The Indian health care system. Available at: https://international.commonwealthfund.org/countries/india/. Accessed February 15, 2020.
6 | The Commonwealth Fund. Health insurance coverage eight years after the ACA. Available at: https://www. commonwealthfund.org/publications/issue-briefs/2019/ feb/health-insurance-coverage-eight-years-after-aca. Accessed March 10, 2020
7 | The Commonwealth Fund. Variations on a theme: A look at universal health coverage in eight countries. Available at: https://www.commonwealthfund.org/blog/2019/universal-health-coverage-eight-countries. Accessed May 7, 2020.