Increasing access to health care

Strategy overview

Promoting and improving access to health care: Increasing access to basic health care services creates the conditions for healthier individuals and families. Strategies to reduce barriers to health care access include federally-qualified health centers, mobile health clinics and tele-health appointments, and financial incentives for preventive care.
Bringing health care to the patients: Traveling to a health care facility can be challenging for some individuals and present a barrier to accessing health care. Offering patients the option to access basic health care services virtually or closer to home can increase uptake. Examples of this approach include phone-based applications to deliver mental health services, mobile clinics that provide reproductive health services, and federally-qualified health centers (FQHC).
Leveraging federal funding to increase access: Cost is a key barrier to health care access for low- and moderate-income individuals. Federally-qualified health centers are public and nonprofit health care organizations that receive subsidies to provide comprehensive care to an underserved area or population. This approach ensures uninsured or underinsured patients have access to basic health care regardless of ability to pay.
Incentivizing preventive care services: Preventive care procedures, like screenings and vaccinations, aim to prevent or reduce the severity of future health problems. One way to increase uptake of preventive care is to offer patients financial incentives, which can offset any out-of-pocket costs for accessing care or reward preventive health behaviors.

Issue Areas: Health and well-being
Outcomes: Stable and healthy families
Target Population: Adults and families, Community-wide
Key Stakeholders: Mayor or County Executive's Office, Public Health Department, Nonprofit Partners, Healthcare Systems, Program Evaluation Team

What evidence supports this strategy?

Multiple research syntheses of common practices to increase access to health care found significant positive impacts on health care uptake and mental and physical health outcomes.

A 2018 research synthesis found strong evidence that financial incentives like vouchers and subsidies were associated with increased use of preventative care for high-risk and low-income individuals.
A 2016 research synthesis found strong evidence that federally qualified health centers were associated with a significant increase in health care access and improved health outcomes.
A 2018 research synthesis found some evidence that mobile reproductive health clinics increase initiation of prenatal care; further research is needed to confirm effects.
A 2018 research synthesis found that text- and app-based mental health services can improve mental health outcomes in the short term; however, further research is needed to confirm long-term effects.

Is this strategy right for my community?

Increasing access to health services is an outcome identified by the Urban Institute as predictive of upward mobility.

City and county leaders can assess local conditions for this outcome using the metrics below, identified by the Urban Institute. This assessment can be used to determine whether this strategy is appropriate for their community. (Note: these metrics are a starting point for self-assessment and are not intended to be comprehensive.)

All cities and counties with populations over 75,000 can receive a customized data sheet here.

Measuring access to health services in your community: Examine the ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.

Best practices in implementation

Focus on community engagement: When individuals trust their health care provider, they are more likely to seek care. Engaging with community members in the design and operation of a program builds familiarity and trust, thereby making uptake and participation more likely.
Develop partnerships to provide comprehensive, coordinated care: Programs should build formal relationships with providers in other specialties. By integrating care, providers can help patients navigate the health care environment and address their needs. Examples of this approach include implementing the Patient-Centered Medical Home model and providing patient navigation services.
Consider patient experience: Patients can face a number of barriers to accessing care, including those related to cost, insurance coverage, transportation, language barriers, and more. Designing strategies to account for these barriers will increase uptake and improve equity in access to care.
Emphasize preventive care: Preventive care, like check-ups and screenings, can help providers and patients identify health problems early, when they are most treatable. Increasing uptake of preventive care in a community can improve overall health and reduce costs associated with managing more serious illness in the future.

Evidence-based examples

	Outcome Area
Community health workers Provides health outreach, education, referral and follow-up, case management, advocacy, and home visiting services	Supportive neighborhoods Stable and healthy families	Promising Strong Proven
Culturally adapted health care Tailored health care to patients’ norms, beliefs, values, language, and literacy skills	Stable and healthy families	Promising Strong Proven
Federally-qualified health centers Delivers comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay	Stable and healthy families Supportive neighborhoods	Promising Strong Proven
Financial incentives for preventative care Financial incentives such as payments and vouchers used to encourage patients to engage in preventative care, like screenings and vaccinations	Stable and healthy families Supportive neighborhoods	Promising Strong Proven
Medical homes Primary care providers and their teams coordinate care across the health care system, working with patients to address all of their health care needs	Stable and healthy families Supportive neighborhoods	Promising Strong Proven
Mobile health for mental health Uses text messaging and mobile device applications to deliver health care services	Supportive neighborhoods	Promising Strong Proven
Mobile reproductive health clinics Medically equipped vans staffed by clinicians offering reproductive health services	Supportive neighborhoods	Promising Strong Proven

Learn more:

Rural Health Information Hub: Federally Qualified Health Centers Information American Medical Association: Digital Health Implementation Playbooks Harvard Medical School: Mobile Health Map Centre for Effective Practices: Mobile Clinic Checklist Washington State Department of HHS: Telehealth Implementation Guidebook