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Strengthening relationships with underserved communities is key to improving health care equity


It's up to providers, payers and health care institutions to bring underserved groups into the system to improve health outcomes

Participating in the health care system can be a daunting task for anyone. But especially for those in underserved populations.

Because health care is a necessity, becoming a part of the system is a necessity, as well. Nevertheless, accessing health care services can be problematic and difficult. Even those of us who work in health care and purportedly have an inside track on knowledge and information often have a difficult time navigating the labyrinth.

For underrepresented, underserved populations, working through the maze of health insurance plans, co-pays, deductibles, in-network or out-of-network providers and the often prohibitive cost of treatment may thwart the regular use of services that, with easier access, can help lower exacerbation of chronic conditions and lower costs.

Unfortunately, our healthcare system doesn’t always do a great job serving its customers. According to a 2022 survey, Americans give the healthcare system a D- and D+ for the cost of care and equitable care, respectively.

“Nearly half of adults report healthcare in the U.S. is poor or failing,” according to the 2022 Healthcare in American Report. “Out of four specific aspects of the healthcare system, cost of care fared the worst by far: Three in four Americans grade affordability a D or an F, a sentiment shared across nearly all demographic groups.”

These issues impact many people who already don’t receive a high level of support from the health care system and, therefore, may go years without receiving any medical treatments at all. Naturally, this negatively impacts health equity, exacerbates chronic conditions and causes medical costs to increase as people use the emergency department, for example, for primary care only when an illness rises to such a level that the individual must enter the healthcare system.

Rebuilding trust in healthcare

The demographic groups who are often most impacted by a lack of regular, affordable access to health care range from disenfranchised to older adults, from marginalized ethnic groups to LGBTQIA+. Mistrust of the health care system is a long-standing issue among these groups.

“Generations of racism and mistreatment at the hands of medical professionals have left many Black Americans distrustful of the health care system,” according to The Commonwealth Fund. “(R)esearchers have found that medical mistrust is not just related to past legacies of mistreatment, but also stems from people’s contemporary experiences of discrimination in healthcare — from inequities in access to health insurance, healthcare facilities, and treatments to institutional practices that make it more difficult for Black Americans to obtain care.”

COVID vaccinations are a recent example of medical mistrust: “Black Americans continue to stand out as less inclined to get vaccinated than other racial and ethnic groups: 42% would do so, compared with 63% of Hispanic and 61% of White adults,” according to a Pew Research Center study.

These groups may be effectively “hidden” from the health care system due to a reluctance to deal with or participate in the system. Therefore, they may not receive a high level of support from health care providers and not use

services that can help maintain or improve health and wellness.

Distrust of the health care system exists, and it’s up to that same system to make the changes necessary to improve and earn the trust that can make a difference to an individual’s health.

“Conceptually, mistrust of the medical care system contributes to delay in care seeking, which complicates the care process and often worsens patient outcomes,” according to research published in an article in Health Services Research. “Delays in seeking care can lead patients to initiate care at later stages of disease progression, increasing the costs of treatment. Moreover, as racial/ethnic minorities report more mistrust of health care, mistrust may be an explanation for disparities in health care utilization and adherence. And there may be race differences in the magnitude of the effect of medical mistrust on health services use.”

As more and more data pours into the healthcare system, the use of algorithms to inform decision-making will undoubtedly increase. Today, many algorithms are, in fact, biased. Keeping these algorithms in check, however, and ensuring that they are unbiased is crucial to the future of healthcare and those who receive it.

A lack of trust in the healthcare system—and sometimes all it takes is one bad experience—is a contributing factor to poor health.

Building relationships

To help improve this nationwide issue the health care system—providers, health plans, community organizations and others—must come together to build relationships with these disenfranchised groups.

While there are myriad reasons that people are wary of the healthcare system from personal experience or those of friends or loved ones, it’s up to that same system to combat that skepticism through transparency and open communication. Starting the conversation is the first step.

When people don’t trust the health care system, their costs and risk may increase. Going years without regular, preventive healthcare treatments can cause chronic conditions to worsen over time. There are fewer opportunities to intervene and provide necessary care.

Connecting the health care system and patients in a positive, empathetic, respectful way may help lessen the fatigue many groups have with the healthcare system at-large and individual healthcare providers, while improving health equity.

Heath Sampson is CEO of Modivcare.

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