Opinion: Barriers to healthcare hurt patients



In Texas’ three legislative sessions this year, our leaders focused on restricting vote, health services and freedom of speech. In the meantime, they have once again failed to act to improve access to health care for their constituents despite bipartite support for the last bill, Live Well Texas (HB 3871/SB 117). Their priorities are seriously misplaced. Opposition lawmakers may not realize that barriers to accessing healthcare are having negative impacts not only on low-income Texans, but also on providers who struggle to serve them.

I know this from personal experience as an internist and pediatrician who has provided primary care services to uninsured and underinsured adults and children for the past decade – notably, since just after the adoption of the Affordable Care Act. I practiced in Florida – another state with extremely restricted access to Medicaid – and Maryland before returning to my beloved Texas. It’s hard to overstate how much easier it was to get my job done in a state like Maryland where people who work hard but still cannot afford insurance had the option to enroll in Medicaid. If a patient needed a life-saving medication or a diagnosis, I would place an order and it usually happened.

Playing in Texas was a different ball game. I think of my patient who might have blockages in his heart that could lead to a heart attack, but who is unable to have a stress test because it costs over $ 500 out of his pocket. So while I can try to lower his heart risk with medication, we both have to live knowing that he may have a time bomb in his chest that could devastate his life and the lives of those close to him. I think of the woman with a rotator cuff injury that threatens her livelihood by preventing her from cleaning homes like she used to do. Evidence shows that physical therapy can lead to significant improvement, but she lacks access to these services, which leads her and her family further into poverty. The examples are so numerous that it is almost banal; sometimes I have to remember that it’s not normal. Or rather, it’s normal but shouldn’t be.

The stress of constantly battling a failed system to do its job takes its toll. We see this in the high rates of burnout and turnover among primary care providers who see unfunded patients. There is a growing consensus that moral prejudice – defined as “the damage caused to his conscience or his moral compass when a person commits, witnesses or fails to prevent acts which transgress his own moral beliefs, values ​​or ethical codes of conduct” – is impacting healthcare providers and reduce their efficiency and job satisfaction. This creates a vicious circle; the difficulty of caring for this population produces a tired and shrunken primary care workforce that is stretched beyond reason.

The COVID-19 pandemic has exacerbated the sense of helplessness among providers. While the entire population suffered unimaginable death and suffering, providers experienced increased burnout and possibly even a loss of life. peak suicide rates which were already higher than in the general population. It’s not a new issue, but, like so many other long-standing issues, the pandemic has made it unique.

I love my career in medicine because of the unique combination of scientific application and human interaction. But when my application of science is limited by the lack of patient access to appropriate services and my human interaction is limited by unreasonably short visits due to unpaid care and low reimbursement rates, it becomes more difficult. to love work and have an impact on health.

Of course, the suffering of the patients is far greater than the relatively minor tribulations of their clinicians. But if officials don’t listen to the stories of uninsured patients, they may be listening to the complaints of their often more privileged providers.

I am writing to fully support the efforts of the United States Congress to identify a health care solution for low-income Texans where our own state lawmakers have repeatedly failed. As Texas remains the Least insured state in the country, Congress must create opportunities for access to health care for those less fortunate among us – for their own sake and for those of us who care for them.

Brandon Altillo MD, MPH, is Assistant Professor of Population Health, Internal Medicine, and Pediatrics at the University of Texas at Austin Dell Medical School, and practices internal medicine and pediatrics in primary care at the Lone Star Circle of Care. . He is a Public Voices member of the OpEd project.



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