Beyond Insurance: Exploring Additional Patient Eligibility Factors

When it comes to healthcare, all individuals must be eligible to have healthcare access. This can often involve insurance. However, the article shows that there is a lot more to determining whether or not a patient can or cannot avail of medical assistance.

Understanding Patient Eligibility: More Than Just Insurance 

In the past, Healthcare access relied only on insurance coverage. However, it is now known that other factors can determine whether a person can get medical help or not. Some of these include:

• Money:   Even if you are insured, people with little money may find it hard to settle out-of-pocket expenses like copays and deductibles making it too hard for them to have healthcare access.

• Where They Live:  The fact is patients living in rural areas may have a problem getting healthcare access to specialized care or diagnostic tests because it is quite far from the offices of health providers.

• Getting There: Individuals who do not have personal transportation to get to a doctor’s office may be limited in their ability to utilize transportation and in turn have healthcare access. 

• Language Barrier: Patients who are unable to understand English-speaking doctors’ advice during the consultation and do not fully comprehend all the medical news treatment prescribed.

• Culture: Health belief systems are influenced significantly by culture, which varies radically across population groups. A physician who is unaware of the hospital’s clientele demographics and who fails to respect the patient’s cultural beliefs will be unable to foster trust to create a connection with the patients. 

Adults Who Did Not See A Doctor Due to High Cost

State	% People Who Did Not Go To See A Doctor
Rhode Island	9.0
South Carolina	5.6
Pennsylvania	6.3
Oregon	7.3
Oklahoma	12.0
Ohio	6.9
North Dakota	5.1
North Carolina	10.6
New York	7.6
New Mexico	8.3

 

Why These Things Matter For Healthcare Access

When it comes to healthcare access, these factors can serve as obstacles, which can make getting healthcare for those who are in need difficult. And this sometimes can turn into:

• Waiting Too Long: People’s health problems could worsen if they can’t see a doctor immediately— avoid waiting too long.

• Skipping Checkups:  Missing opportunities to address health issues is a likely scenario for those who cannot afford regular checkups, thus think twice about skipping checkups. 

• Costing More: It is common sense that if an individual delays seeking medical attention, the cost of treating the health complication might escalate — consider this when deliberating on procrastination.

Making it Easier for People to Get Care 

Many things can be done from our end which can improve healthcare access for patients. 

• Discounts: Healthcare can offer discounts on their treatments to make them affordable to more patients.
  

• Doctor Visits by Phone or Video: Healthcare providers can leverage telemedicine to make their healthcare access accessible to remote areas or to people who cannot travel to their clinic.
  

• Help Getting to Appointments: Some programs offer rides or vouchers for transportation to doctor’s offices
  

• Translators: Doctors can have people who translate languages so everyone can understand each other.
  

• Learning About Different Cultures: Doctors can take classes or workshops to learn about different cultures and beliefs about health.
  

Working Together for Better Access 

To make it easier for everyone to see a doctor, different groups need to work together:

• Doctors and Hospitals: They can offer the programs mentioned above.
  

• Government: They can make laws that help people afford care and make sure there are enough doctors in rural areas.
  

• Community Groups: They can help people find out about the programs and services available to them.
  

• Technology Companies: They can create tools that make it easier for people to see doctors by phone or video.

When we comprehend the factors that influence a patient’s capacity to obtain care, it can be a collective effort where all individuals cooperate and ensure universal availability of required healthcare. It benefits everyone as it allows people to maintain their health with ease, which is in turn cost-effective in reducing the overall healthcare costs.

Patients might find it difficult to obtain health care despite having insurance because of reasons like copays or deductibles. Capline’s patient eligibility services can give your practice power. We quickly and effectively check insurance coverage so that you get the latest information at hand before appointments — which in turn ensures no-show billing and surprise contact with denied claims for patients. Capline, moreover, can recognize those seeking help from financial assistance programs; this will better reach everyone who needs care. Let Capline assist you in concentrating on the essential aspect— outstanding patient care that matters most.