By: Vasundhara Gray, Senior Associate, Content Management, dentsu health; Rupali Bajaj, Senior Research Associate, dentsu health; Kent Groves, PhD, Global Head of Strategy, dentsu health
We cannot deny that progress in healthcare has been exponential. 100 years ago, an operation to remove an infected appendix was a risky procedure. Tuberculosis, influenza, and pneumonia claimed millions of lives, and even a surgery to repair a common fracture could have had broad-reaching negative health impacts. Today, OTC drugs, day surgery and comprehensive drug plans save most of those lives that would have otherwise been lost. In many respects this progress is nothing short of miraculous, but these advances truly become moot without parallel progress in access to the science.
Do cutting-edge advances in healthcare also mean easily accessible healthcare?
COVID-19 provided some insight. The US saw the cracks in its healthcare system amplified as unemployment and layoffs led to millions of Americans losing their employer-sponsored health insurance. Visits to primary care physicians and specialists declined and many hospitals postponed or cancelled elective treatments. Even cancer screenings saw a sharp dip—the steepest fall being 94% for breast cancer. While the pandemic brought the topic of access to the forefront, it has been a long-standing deficiency in our care systems.
The WHO says that nearly half the global population lacks essential medical care. In the US, over 26,000 people die each year due to insufficient health insurance coverage. Accessibility is not necessarily just about physical or geographic restrictions, but it can also be driven by limited availability of therapeutics. Consider, the EU often faces medication shortages, impacting 47% of patients, a 2019 EAHP study uncovers. Consequences may range from disease progression to reduced life expectancy. The scenario is gloomier for cancer patients as medication scarcity may hinder their survival.
APAC, too, grapples with accessibility limitations, especially in the case of women living in low-income households or rural areas. Inaccessibility also contributes to maternal deaths, especially in the least developed regions. Sub-Saharan Africa accounts for 66% of maternal deaths. South Asia adds another 20%.
The scale of urbanization imparts another dimension to this issue. As can be expected, the number of primary care providers per capita is lower for rural areas in comparison to urban areas. This adds to the burden of travel and associated costs to reach health providers, pushing many people to delay or give up seeking care altogether.
What’s driving the gaps between patients and basic, often life-saving, healthcare?
Steep healthcare costs, especially high out-of-pocket costs stand out as a prominent barrier. The Commonwealth Fund’s 2020 report says that 38% of US adults and 50% of low-income adults had gone without medical care, citing unaffordability as the primary reason. This restriction pinches higher income individuals as well - 27% of high wage-makers skipped healthcare, the same report unveiled. Moreover, 20% of the US households making more than $120,000 annually didn't access healthcare in February, March, and April 2022, a survey of 6,500 respondents revealed. Choosing between medical attention and basic utilities is not an easy choice to make.
The problem doesn’t end there; it runs deeper and spreads across the societal framework, with discriminatory practices like systemic racism, sexism, and ableism. Redlining denies services based on race, and implicit bias affects one in 10 Black patients. Women lacking decision-making autonomy face medical access challenges. Over 1 billion people with disabilities also struggle for healthcare. Their needs can be better addressed and represented through health policy, research, and practice.
What are the elements of the prescription for improving this situation?
Establishing Universal Health Coverage (UHC) is a step in the right direction. A UN sustainable development goal, UHC refers to providing health access to all the people - what they need and when they need it - without the associated liability of financial strain. The Organization for Economic Co-operation and Development (OECD), in collaboration with WHO and the World Bank, is working towards UHC2030, which includes setting up strategies and promoting the translation of UHC commitments into actionable measures in countries.
National and regional governments, too, have a role to play. The US government, with its Medicare and Medicaid health coverage programs, has provided a reasonable model. While the former is a federal health insurance, the latter is state-managed and administered. The State Children’s Health Insurance Program (SCHIP) and the Indian Health Service (IHS) program, along with 90 programs provided by the Health Resources & Services Administration (HRSA) help millions lead better, healthier lives.
Canada, too, has a robust healthcare network. It comprises 13 systems – one for each province and territory – with notable plans like Québec Health Insurance Plan, the Ontario Health Insurance Plan, and eHealth Saskatchewan.
The UK's National Health Service (NHS) provides coverage to everyone, regardless of citizenship or immigration status. This includes primary and dental care, hospital and specialist services, and local health authority provisions. Japan's healthcare system, ranked third globally by the Health Care Index 2024, emphasizes preventive care and mandates coverage for all citizens, residents, and visitors staying over three months. This care system includes over 3,000 health insurance funds.
Meanwhile, India's Ayushman Bharat National Health Protection Scheme covers over 500 million citizens, offering ₹500K per family annually for secondary and tertiary care.
While government programs are a substantial support for many, some segments of society may benefit from a more protective approach too. People with disabilities are one such cohort. Protective laws like the Americans with Disabilities Act (ADA) mandate all public healthcare institutions to ensure equal access to people with disabilities. This could be done by modifying policies, procedures, or practices; making communication effective and easy to understand; and implementing physical accessibility.
The European Accessibility Act (EAA), which is set to be implemented in 2025, aims to widen the net of accessibility across a variety of digital and physical products and services. While it doesn't address healthcare directly, a broad directive such as this can be expected to have positive implications in the healthcare space for people with restricted abilities. Legal frameworks like these could foster an accessible environment where patients feel understood, respected, and represented.
Pharmaceutical companies, too, have a stake in making expensive healthcare an easier pill to swallow. Merck’s Patient Assistance Program is worthy of note. The company offers certain medicines and vaccines free for up to one year to eligible patients who are uninsured or to insured patients whose coverage does not include their prescribed Merck medication. The Novartis Access Program takes a more focused approach by easing access to a portfolio of drugs for non-communicable diseases in lower-middle income countries (LMICs).
Some pharma companies also opened their pillbox for some of the most prevalent diseases. During the pandemic, Pfizer and BioNTech provided the Comirnaty COVID-19 vaccine for free under a $30 per dose government-funded agreement. Eli Lily also capped the out-of-pocket cost of its insulin injectables like Humalog and Lispro at 35 USD a month. Their 70% price cut, along with Sanofi's and Novo Nordisk's 78% and 75% markdowns on their insulin drugs were driven by the Biden administration's Inflation Reduction Act. These rebates can sweeten (or in this case, unsweeten) the lives of millions of diabetics that make up 11% of the US populace.
The Runway Before Us
Inaccessible healthcare due to geography, lack of transport, and poor infrastructure highlight the importance of digital intervention in healthcare. Telehealth, using video conferencing and cloud data, connects physicians with patients across distances, improving access and reducing travel costs. Mobile healthcare and emergency services also bridge geographic gaps, offering urgent care to underserved areas. Drones further enhance remote healthcare by delivering vital supplies and facilitating quick medical responses, like transporting samples and organs.
A healthcare ecosystem is only as sound as the most vulnerable sections of society it can include and serve. Clearly, addressing disparities in healthcare access requires a multi-dimensional approach. It takes a thorough understanding of the social, economic, and geographical aspects of healthcare to weave a solution that is inclusive, impactful, and equitable. Government, big pharma, policymakers, HCPs, caregivers, and patients all have a role to play. While some audiences can inspire change in accessibility, others can ideate and act on it, and some can reinforce it. What matters is that we work together to create a future where equal access to healthcare is no longer a goal, but a norm.