Ensuring adequate access to health care is critical to achieving positive health outcomes. However, the Commonwealth Fund ranked the U.S. last among 11 high-income countries in terms of access to health care in a 2021 report.
Patients in the U.S. have difficulty accessing quality health care for a number of reasons. From a lack of health insurance to a shortage of medical professionals, many factors keep patients from receiving the care they need.
Fortunately, nurse practitioners (NPs) can help improve access to health care for many Americans. Equipped with advanced expertise, NPs can close gaps in health care and provide services to patients who might otherwise go untreated.
Nurses who are interested in advancing their careers by enrolling in an nurse practitioner specialties can benefit from learning more about nurse practitioners’ potential for strengthening access to health care.
Barriers to Health Care Access in the U.S.
Several factors limit access to health care in the U.S. The specific barriers to health care access discussed below represent some of the most significant roadblocks that patients encounter.
Lack of Health Insurance
According to a report from KFF, a nonprofit focusing on national health issues, in 2021, 27.5 million nonelderly people in the U.S. had no health insurance.
Even individuals who have health insurance can suffer from gaps in their insurance coverage or inadequate insurance. When the Commonwealth Fund surveyed U.S. adults under age 65 in 2022, it found that:
- Eleven percent had a gap in health insurance coverage during the past year.
- Twenty-three percent had health insurance coverage that did not provide affordable access to health care.
High Medical Costs
The cost of health care also represents a hurdle for many people. When KFF polled adults under age 65 in 2022, it found that:
- Forty-seven percent said it was difficult to afford health care costs.
- Forty-three percent said they had postponed getting treatment they needed because of the associated cost.
The cost of health care is considerably higher in the U.S. than in other countries. A 2022 report from the Peterson Center on Healthcare and KFF found that annual per capita spending on health care in the U.S. was $11,945, while average annual per capita spending on health care in other wealthy countries was $5,736.
Shortages of Medical Professionals
Improving access to health care will require addressing a significant shortage of medical professionals across the country. The American Association of Medical Colleges reported in 2021 that, by 2034, the U.S. will experience:
- A shortage of between 17,800 and 48,000 primary care physicians.
- A shortage of between 21,000 and 77,100 physicians who specialize in something other than primary care.
Those shortages are being driven by both population growth and an aging population with increasing health care needs.
Geographic and Transportation Issues
Patients who live in rural areas are more likely to have difficulty accessing health care. Even when patients can get an appointment with a provider, they may still experience challenges keeping those appointments because of transportation issues such as an inability to drive, a lack of access to any means of transportation, or a lack of access to affordable public transportation.
To strengthen access to health care, health care systems will need to address language barriers. According to a 2022 report by information services firm Wolters Kluwer, 20% of U.S. households speak a language other than English. This can have detrimental effects on health care access. Specifically:
- In 2021, BMC Health Services Research published the results of a study that found limited English language proficiency often delayed access to health care services.
- In 2022, the U.S. Department of Health and Human Services reported that language barriers can result in individuals deciding not to seek health care at all.
Insufficient Patient Education
Adequate patient education is vital to ensuring patients know when to seek out important preventive services such as health screenings and vaccinations. Patients also need to be educated on how to navigate complex health care systems.
A study published in Health Literacy Research and Practice in 2020 established a link between relatively low health literacy and limited access to health care. The study suggested that improving health literacy empowered patients to take better control over their health and improved their ability to access health care.
Stigma Associated with Seeking Treatment for Mental Illness
According to an article published in SSM – Population Health in 2021, the social stigma associated with mental illness may affect patients’ ability to access mental health care. For example, a perceived stigma can affect patients’ perceptions of themselves, which can exacerbate their mental health challenges and make it more difficult to access care. In addition, patients who have mental health challenges sometimes encounter health care professionals who may be influenced by biases about mental health, which can make it hard for these patients to navigate the health care system.
How the COVID-19 Pandemic Affected Health Care Access
The COVID-19 pandemic presented additional hurdles that have impaired health care access. For example, as JAMA Health Forum reported in 2021, many patients delayed care during the pandemic. As a result, a backlog of postponed medical needs has exacerbated difficulties in accessing care.
According to an article published in the International Journal of Environmental Research and Public Health in 2022, other factors associated with the pandemic also reduced access to health care. For example:
- Patients’ fears of contagion caused them to forgo health care.
- The pandemic created and exacerbated mental health issues such as anxiety; this increased the demand for mental health care, which further hampered patients’ ability to access that care.
- While the use of telehealth increased during the pandemic — improving access for some — new barriers to access arose for patients who did not have the technology or the technical knowledge to use telehealth services.
The Consequences of Limited Health Care Access
When patients face limits on health care access, the negative consequences can be far-reaching. Examples of the potential consequences include:
- Reduced life expectancy. In 2022, the Commonwealth Fund reported that average life expectancy was lower in the U.S. (78.8 years) than it was in other middle- and high-income countries. For example, average life expectancy was 82.3 years in Canada and 84.4 years in Japan. The report attributed reduced life expectancy, in part, to issues that impair access to health care in the U.S.
- Poor health resulting from skipping or delaying treatment. When patients skip or delay care for chronic conditions, this can result in more serious, long-term health complications, according to a study published in the Journal of the American Geriatrics Society.
- Poor health resulting from unfilled prescriptions. The Patient Access Network Foundation (a nonprofit organization that assists people in the U.S. with paying medical expenses) has noted that patients who do not fill prescriptions risk the progression of their disease and hospitalization.
- Deterioration in maternal health. According to a 2022 report in HealthLeaders, the maternal death rate increased by 14% between 2019 and 2020. The report attributed that increase largely to access issues that prevented mothers from obtaining vital services such as prenatal care.
- Increased use of emergency departments for primary care services. A study of emergency department visits published in Military Medicine in 2022 found that more than half of the emergency department visits analyzed were for conditions that a primary care provider could have addressed. The study cited issues in access to care as one reason patients visited emergency departments for primary care.
Improving access to health care also can help to reduce certain economic consequences, such as:
- Greater risk of poverty. As a 2022 report in The Balance noted, individuals who have poor health due to issues such as inadequate access to health care are more likely to live in poverty, and the high cost of health care can drive people into poverty.
- Excess medical costs and losses in productivity. A 2021 report by KFF asserted that disparities in health care (including issues in access to care) resulted in:
- Excess medical costs of $93 billion each year
- Lost productivity of $42 billion annually
The Unique Role of Nurse Practitioners
Nurse practitioners possess the skills and expertise to help make tremendous strides in enhancing access to health care. According to the American Association of Nurse Practitioners (AANP), the unique nature of their clinical expertise and their emphasis on managing health and preventing disease enable nurse practitioners to use a comprehensive approach to providing health care.
Nurse Practitioner Scope of Practice
Examining aspects of the nurse practitioner scope of practice helps to explain their overall role as well as their ability to help close gaps in care. According to AANP, nurse practitioners:
- Offer services such as assessing patients, ordering and reviewing diagnostic tests, diagnosing patients, and creating and managing treatment plans
- Can work in almost any health care setting, including private practices, clinics, hospitals, and public health departments
- Can either work autonomously or coordinate their work with other medical professionals
Nurse Practitioner Specialties
Nurse practitioners can help improve access to health care for patients within their particular specialization. Examples of nurse practitioner specialties include:
- Adult Gerontology — Acute Care Nurse Practitioner (AGACNP). AGACNPs treat adult patients ranging from adolescents to older adults. They provide acute care to patients who are in critical condition, face serious illness, or have experienced traumatic injuries. AGACNPs perform procedures such as intubation.
- Adult Gerontology — Primary Care Nurse Practitioner (AGPCNP). AGPCNPs treat the same patient demographic as their acute care counterparts. However, AGPCNPs focus on providing primary care in settings such as long-term care facilities, clinics, and private practices. Examples of their services include performing examinations and ordering and interpreting tests.
- Family Nurse Practitioner (FNP). FNPs work with patients throughout their entire life span. Working in settings such as clinics and physicians’ offices, they diagnose illnesses, develop treatments, and order and review the results of diagnostic tests. A significant part of an FNP’s work also involves educating patients on preventing disease and promoting good health.
- Pediatric Nurse Practitioner (PNP). PNPs concentrate on treating children ranging from infants to young adults. They work in settings such as physicians’ offices and offer services such as developmental screenings, well-child exams, and treatment for childhood illnesses. They also educate family members on caring for sick children.
- Psychiatric Mental Health Nurse Practitioner (PMHNP). PMHNPs focus on treating patients’ mental health conditions. Working in settings such as private practices and community agencies, PMHNPs analyze patients’ patterns of behavior, administer treatment plans, and educate family members about patients’ conditions.
- Women’s Health Nurse Practitioner (WHNP). WHNPs concentrate on treating the health care needs of women. They work in settings such as private practices and provide services such as well-woman exams, prenatal care, fertility evaluations, and breast cancer screenings.
Nurse Practitioner Training
Proper training of nurse practitioners is key to preparing them to help increase access to health care. Becoming a nurse practitioner entails:
- Earning a bachelor’s degree in nursing
- Passing the National Council Licensure Examination (NCLEX) and becoming a registered nurse
- Earning a graduate nursing degree (either a Master of Science in Nursing or a Doctor of Nursing Practice)
- Passing the certification exam for their preferred nurse practitioner specialization, and obtaining state licensure as a nurse practitioner
Nurses who have already earned a graduate degree but want to become nurse practitioners (or nurse practitioners who want to enter a new specialty) can enroll in a post-master’s certificate program. These programs focus on the knowledge nurses need to work in their preferred specialization.
How Nurse Practitioners Improve Access to Health Care in the U.S.
Nurse practitioners are uniquely positioned to help expand access to health care in the U.S., in large part due to ongoing shortages of medical professionals.
- Shortages in primary care. Nurse practitioners with expertise in primary care can help fill the gaps in care that will result from the looming shortage of primary care physicians.
- Shortages in mental health care. According to KFF, as of September 2022, the U.S. faced a shortage of nearly 7,900 mental health practitioners. This represents an opportunity for nurse practitioners who have expertise in mental health.
Given these shortages, it’s no surprise that nurse practitioners are in extremely high demand. The U.S. Bureau of Labor Statistics reports that employment of nurse practitioners will grow by 46% by 2031, creating nearly 113,000 new jobs.
Examples of Nurse Practitioners Improving Access to Health Care
The ways in which nurse practitioners can expand access to health care go beyond simply helping to address shortages of medical professionals.
PMHNPs Are Helping to Meet the Growing Demand for Mental Health Care
While the supply of mental health care providers is insufficient, the demand for mental health care services continues to grow. According to the American Psychological Association, 79% of the psychologists it surveyed in 2022 reported an increase in anxiety disorders and 66% reported an increase in depressive disorders.
Fortunately, patients understand that PMHNPs can help meet their mental health needs. A 2022 article in JAMA Network Open reported that the number of PMHNPs providing care to Medicare patients more than doubled between 2013 and 2019. The article noted that the increasing number of PMHNPs could help address issues in access to mental health care.
FNPs Are Helping to Meet the Need for Primary Care in Rural Areas
In 2020, the National Rural Health Association reported on the vital role that nurse practitioners who provide primary care play in expanding access to primary care in rural areas. According to the report, the number of nurse practitioners in these areas is increasing, and almost half of all rural primary care practices employ at least one nurse practitioner. The number of nurse practitioners who practice on their own in rural areas also is on the rise.
AGPCNPs Can Provide Quality Primary Care While Also Reducing Service Utilization
In addition to addressing shortages of primary care physicians, nurse practitioners can help reduce the need for utilization of health care services. A 2020 study published in Health Services Research compared primary care patients who received care from nurse practitioners with primary care patients who received care from primary care physicians. The study concluded that nurse practitioners’ patients had similar health outcomes but required fewer outpatient services and experienced fewer hospitalizations than primary care physicians’ patients. Reducing service utilization and hospitalizations can help improve health care access for all.
WHNPs Can Help Address Challenges in Access to Maternal Health Care
A significant part of improving health care access involves addressing serious problems in accessing maternal health care. In 2022, the March of Dimes designated 36% of U.S. counties as “maternity care deserts,” in which access to maternity care was limited or nonexistent. The U.S. Department of Health and Human Services has specifically cited growth in the ranks of WHNPs as a factor that can help to alleviate challenges in accessing maternal health care.
Nurse Practitioner Private Practice
Nurse practitioners’ increasing ability to open their own practices and operate autonomously creates new avenues for patients to access health care.
A 2022 report in Patient Engagement HIT noted that, during the COVID-19 pandemic, certain states expanded nurse practitioners’ ability to provide care by granting them full practice authority. Some states are now making those changes permanent. According to AANP, as of October 2022:
- Twenty-six states were considered full practice states. Nurses in these states can evaluate, diagnose, and treat patients (including prescribing medication) under their nurse practitioner licenses without the need for supervision.
- Twenty-four states were considered reduced or restricted practice states. The laws in these states limit what nurse practitioners can do and frequently require them to work under the supervision of other health care providers.
Nurse Practitioners Are on the Front Line in Expanding Health Care Access
Nurse practitioners’ knowledge and experience make them key players in efforts to improve access to health care. With wide-ranging and specialized expertise, nurse practitioners have the ability to provide a variety of services to patients who need care.
Nurses who have earned a graduate degree and wish to become nurse practitioners (or nurse practitioners who want to expand into a new specialty) can explore Regis College’s post master’s certificate nurse practitioner online to learn how the program can help them pursue their professional goals. Offering six specialty certificates, the program can provide the training you need to advance in your nursing career. Take the next step toward your career goals today.