A patient’s ability to obtain health services and achieve the best possible health outcomes. Barriers to access may be structural, financial or personal. The ease of access is determined by such components as the availability of medical services and their acceptability by the patient, the location of health center facilities, transportation, hours of operation, insurance coverage, language, and culture. [Source: Catholic Health Ministry in Transition: A Handbook for Responsible Leadership (Silver Spring, MD: National Coalition on Catholic Healthcare Ministry, 1995).]
In accord with its mission, Catholic healthcare should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parents; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees. In particular, the person with mental or physical disabilities, regardless of the cause or severity, must be treated as a unique person of incomparable worth, with the same right to life and to adequate healthcare as all other persons (Ethical and Religious Directives, Part One, n. 3).
Though only one of many barriers to access, the absence of adequate health insurance due to the lack of affordability remains the primary obstacle to acquiring adequate health care services. At any given time, at least 44 million Americans lack health insurance. This lack of health insurance negatively impacts the health of those who are uninsured. Moreover, uninsured individuals often incur higher-than-necessary costs because they do not seek medical care until their condition has reached a previously preventable degree of severity. These increased costs associated with a lack of insurance are passed on to the public at large. Those who are most likely to be uninsured are: children of low-income families, the working poor (those who earn less than poverty wages are twice as likely to be uninsured than the unemployed poor), and the near-elderly. Recent studies suggest that tax deductions will do little to improve insurance coverage and that tax credits would be more effective but still not as effective as the direct provision of insurance through subsidized public programs. These studies indicate that the latter method is the most efficient and effective way to increase insurance coverage. One means of increasing insurance coverage through public programs would be that of expanding Medicaid coverage to include everyone whose income is below 200 percent of the poverty line, similar to the approach taken in Oregon as it attempted to expand coverage through a Medicaid Priority List. In the three states that have already expanded Medicaid coverage—Oregon, Hawaii and Tennessee—insurance coverage of children rose by 16 percent, access to a primary care physician increased, the utilization of preventative services (such as pap smears) increased, and the level of unmet medical need and out-of-pocket expenses was reduced. [Sources: The Council of Economic Advisers, "Reaching the Uninsured: Alternative Approaches to Expanding Health Insurance Access," The Center on Budget and Policy Priorities, "The Importance of Family-Based Insurance Expansions: New Research Findings about State Health Reforms."]
