Access to Care: What It Means in the U.S. and Abroad

According to the Agency for Healthcare Research and Quality (AHRQ), "[A]ccess to health care means having "the timely use of personal health services to achieve the best health outcomes."

Three items are used to determine access to care:

• Entering the healthcare system;

• Accessing providers so that patients can receive needed services; and

• Finding providers who can address an individual patient's needs and establish a mutually trusting relationship.

Interestingly, what is absent is who pays for this access. Depending on a person's circumstances, it could be a sliding scale for a cash payment, private insurance, or a government program (e.g., Medicare or Medicaid). Or, the care provided could be considered "charitable care" and written off as bad debt. These are typical scenarios that physicians and hospitals have to deal with in the United States and abroad.

Medical tourism is another option. But, medical tourism is not only utilized by patients with the means to pay - it is also utilized by patients who are sponsored by various charitable organizations or persons. Take, for example, FOCOS Orthopedic Hospital, which is located in Ghana and is the "official international affiliate of the renowned Hospital for Special Surgery (HSS) in New York City." The patients at FOCOS come from all over the world to find access to healthcare for complex spine and other orthopedic procedures and are often sponsored by a charitable organization.

So, why am I raising the issue of "access to healthcare?"

The U.S. is about to embark on another change in our healthcare landscape; The Medicare Access and CHIP Reauthorization Act (MACRA) is now in effect; and access to care and payment go hand-in-hand. Physicians in the USA could learn from FOCOS and other entities in relation to their revenue cycle, as well as cost-effective care through monitoring waste, controlling costs and negotiating with patients to pay on a sliding income scale.. With the shift to outcome-based medicine, which is present in the over 2,000 pages of the MACRA final rule, physicians may benefit from re-assessing what access and practice viability mean in relation to each other.