Bridging healthcare gaps: the complex issue of access to care

Access to care cuts across different facets. It touches on aspects of availability, affordability, physical and virtual accessibility and cultural acceptability. These elements are intricately linked and contribute a critical role towards achieving better health outcomes and eventually, the overall life expectancy across different demographics. It’s no surprise that those with less access to care experience poorer health outcomes. Kaiser Permanente Institute for Health Policy [1] recently published a paper on maternal health outcomes. Premature and preventable maternal deaths in the U.S. are still on the rise, and Black women and Native American women are disproportionately affected. The publication highlights issues that contribute to these disparities which include poor access to safe housing, economic inequalities, poor access to health insurance and racial disparities especially for Black mothers. Another publication by the Kaiser Family Foundation [2] highlights disparities for people of color regarding access to a doctor or provider and thus having to go without care. Results of the Future Health Index 2024 [3] indicate that healthcare staffing shortages and provider burnout remain a significant challenge in the U.S., impacting patient care.

These examples are the tip of the iceberg that is the complex nature of what access to care is and how healthcare is experienced by different people.

Take the availability of health insurance or services. Do you have insurance coverage to get access to the healthcare system, and if you do, are you able to access care in a timely manner? Given the significant shortage of physicians and nurses, the health systems cannot accommodate the patients in a timely manner. As an example – to see a cardiologist, you may still have to wait four to six weeks. And that's not ideal in a situation where you're experiencing urgent cardiac issues. Similarly, staffing shortages are not only impacting your access to healthcare but may also impact your health outcomes because practitioners are unable to spend enough time with the patients due to high volumes and administrative burden. I also think of healthcare access from a geographic standpoint. Whether you're in a rural part of the country, urban, or suburban, there's data to suggest that your health outcomes are actually related to where you live, and access to care is a component of that. When I think of gaps based on social determinants of health, I think about zip codes, transportation needs, financial security, digital literacy, racial or gender characteristics – these all combine to form the gaps in access to care that many people face.

Another example is our collaboration with the Bill & Melinda Gates Foundation, where we are working to improve patient access to obstetric care and to enhance the quality of that care with better detection and treatment planning for high-risk pregnancies. In addition, we would like to support healthcare professionals in low-and-middle income countries, and potentially in rural/underserved areas across the world, to confidently operate basic obstetric ultrasound devices. One way will be through reducing ultrasound operation training needs and time from weeks to hours, contributing to solving the challenge of a global shortage of sonographers and insufficient training of healthcare professionals in ultrasound techniques. Through development of AI-driven algorithms built into the Philips Lumify handheld ultrasound, image acquisition or image interpretation for obstetrics measurements can be automated, giving healthcare workers with no specific ultrasound knowledge the ability to perform scans, and with that increase quality access to early fetal ultrasound scans.

Additionally, we participate in transformational initiatives that drive systemic improvement through our ecosystem engagement. One is with the National Academy of Medicine where Roy Jakobs, our CEO, is part of creating a code of conduct for responsible AI development and how it's applied in healthcare [4].

For instance, maternal health doesn’t end once the baby is born. There's this concept of the fourth trimester where maternal health care extends to about three months after pregnancy. A lot of women who experience preeclampsia or complications of high blood pressure during pregnancy are at risk of having adverse cardiovascular outcomes later down the line, and an easy way to help prevent that is to keep a focus on their blood pressure post-delivery. Unfortunately, most healthcare systems don't have resources or programs to address that.

To address this, one health system provided with pre-eclampsia or eclampsia during pregnancy, with a blood pressure cuff and the ability to have a virtual visit post-delivery. Integrating care for postpartum women through virtual visits allows them to manage health challenges and modify risk factors down the line without compromising their responsibilities as new mothers. By providing simple tools like blood pressure cuffs for home monitoring, we enable healthcare to extend beyond traditional settings.

Another way is to bring care to patients in the home setting. American College of Cardiology recently published a home-based care workbook [5] on how to deliver cardiac care at home including use cases. Most home-based care can be delivered using technology that exists today, whether it’s virtual visits, blood pressure cuffs, or even simple things like a scale that communicates with electronic medical records.

Philips organized a Cancer Care at Home Summit in Cambridge a year and a half ago with the goal of gathering the insurance companies, the oncology society, and the industry itself to brainstorm what innovations we need to successfully deliver at-home care for cancer patients and improve access to this care in the setting that they're most comfortable with. The work from this summit was published by American Cancer Society [6], and the collaboration to discover and align on our collective needs and opportunities has set us on a path to drive the work forward. As the paper notes, “Complementing the recent unprecedented expansion of cancer treatment options, cancer care in the place a patient calls home could help address some longstanding barriers to equitable access to care, particularly for populations marginalized because of geography, travel requirements to get to care providers, proximity to clinical trials and overall financial burdens of cancer care [7].”

Lung cancer is the leading cause of cancer death. We know that the lower dose CT can detect early lung cancer much better than an X-ray. And if you screen this way, you can reduce mortality from the disease. In a partnership between Philips and Roswell in Buffalo, New York, we brought mobile CT scanners into the community to offer these screenings in collaboration with the health system so patients can have follow-up for further care, if needed. This is a perfect example of a partnership where we can leverage an existing technology, but there's gap in adoption or access to that technology; even though it’s been shown to promote health. It also shows that there is an opportunity to improve the health of the community by improving access to technology [8].

Considering people’s ability to travel, health systems can look at offering a transportation option. Take a dialysis patient, for example, who needs to be at a center three times a week. Can you provide them with transportation so that they don't have to worry about whether they can make it to this life-saving care? And finally, when I think of things like coronary angiography, which is a very involved procedure mostly done in the hospital setting, there are parts of the country – especially in rural parts of America – where people don’t have ready access to those health systems and services. So, with a concept like an ambulatory surgery center, can you bring that care closer to home?

The other place the mobile CT truck is positioned is outside a fire station. Firefighters are at higher risk of being diagnosed with lung cancer because of the kinds of toxins they're exposed to in the line of their work. Bringing the service closer to them helps to mitigate distance and time constraints as barriers to access.  The program design allows Roswell Park Comprehensive Cancer Center to better engage the community it serves right there in the community. And Philips, through our innovative solutions, is glad to be part of taking care beyond the hospital and into the communities. I love that holistic view in terms of how we're approaching our partnerships.