Benefits and barriers to preventive care

Preventive care is one of the most important ways to protect our health, yet it is estimated that only 8% of Americans undergo routine preventive screenings. Consumers often experience barriers to such care including racial and socioeconomic disparities, a shortage of primary care providers (PCP), long waits for appointments and financial hardships. In fact, four in ten adults (43%) reported that they or a family member in their household put off or postponed needed health care due to cost.

This line of thinking can be flawed, however, since not keeping up with preventive care can cost consumers more money down the road from worsening health conditions and complications that may develop. Here, we explore the benefits of and barriers to preventive care – as well as our work to address health inequities that impact access.

How preventive care impacts consumers

Despite the challenges consumers may face in accessing preventive care, the benefits are significant for both their health and wallet. Four out of the five leading causes of death are caused by chronic diseases that are either preventable or likely to be manageable with regular access to health care. When these diseases are caught early, consumers could save money from not having to need major surgery, medications or more serious medical interventions. It’s also worth noting that under the Affordable Care Act, all private health plans must cover recommended preventive services, so they can be accessed at no cost to the insured consumer.

Preventive care also improves health outcomes—both physical and mental. Heart disease, for example, can be caught early on with regular blood pressure screenings that are recommended annually for adults over 40. This testing can reduce incidents of strokes, heart failure and coronary disease events. Routine cancer screenings that are considered preventive services, such as mammograms and colonoscopies, can detect cancer before it spreads to other parts of the body and becomes more difficult to treat. Mental health screenings for conditions like depression can also help people get support before it affects other areas of their life or becomes unmanageable. With suicide being a leading cause of death in our country, this type of preventive care can be crucial.

Barriers to preventive care

Disparities can impact access to care with preventive services being used substantially lower among racial and ethnic minority groups, rural residents and persons of lower socioeconomic status. A study published by the National Institute of Medicine has revealed that compared to white Americans, both African Americans and Latinos are less likely to have a specific source of ongoing care and less likely to have a PCP.

Finding a PCP to visit for preventive care is also a challenge consumers face. In fact, research projects that physician demand will grow faster than supply, leading to a projected shortage of between 54,100 and 139,000 physicians by 2033. A PCP search can be even more daunting to those with lower incomes or unemployed.

Another barrier to preventive care is cost. For those uninsured, it can be hard to justify visiting a doctor when you aren’t having any problems or symptoms, but skipping preventive care all together can ultimately lead to emergency room visits, where the average cost of treating common primary care treatable conditions is 12 times higher than visiting a physician’s office. Hourly employees may also struggle with taking time off from work and losing income to attend a medical appointment.

If consumers do find a PCP, they are often met with long wait times to actually be seen. A recent survey revealed the time it takes to schedule a new patient physician appointment in 15 major metropolitan areas has increased by 24% since 2004. These practical challenges can often be enough to deter people from scheduling and keeping regular preventive health appointments.

Tackling barriers across the health care system

During the pandemic, the disparities that can impact access to care became clearer and there have been calls for providers and health systems to learn how to work better with both patients and community organizations to improve the use of guideline-recommended preventive services.

Reducing disparities between different racial and geographic populations has also been a priority. Point32Health recently introduced our Social Inequality Index (SII) tool, designed to better understand social determinants of health for our Tufts Health Plan and Harvard Pilgrim Health Care members. The SII integrates into the company’s Population Health Management tool to provide a comprehensive view of populations and individuals by burden of disease, geographies, demographics and utilization patterns. The addition of the SII will allow Point32Health to strategically address and remove barriers to equitable care.

Teams across the organization now have a better understanding of the needs of individual members. For example, care managers use the information to prioritize outreach for members across all products and geographies to help connect them to programs and services they may need to remove barriers to equitable health care.

As the health benefits to keeping up with preventive care are significant, it’s important to continue to navigate the accessibility challenges. This can be a collaborative effort between providers, employers and community organizations with specific outreach to underserved populations.