By Taylor Hughes

Primary care is often considered the gateway into the healthcare system. Primary care services include preventing and treating common illnesses–but that’s not everything. Primary Care Physicians (PCPs), including internists, family physicians, and pediatricians, can form strong patient relationships, manage medical histories, coordinate care with specialists, and respond quickly to patient health changes. While primary care is an essential source of healthcare, disparities exist; not everyone forms this relationship with a primary care provider or visits a primary care office. In many cases, this is because individuals face barriers to accessing care. This is an important issue for policymakers in New Jersey and the United States at large to continue addressing because a lack of access can lead to delayed care and serious financial burdens for individuals.

A variety of factors determine barriers to PCP access, including geographical location, country of origin, insurance status, and more. For example, people with limited English proficiency (LEP) face language and cultural barriers. One study used computer software to simulate the complex relationships between Latinos and PCPs in the United States over time. Five “what if” experimental scenarios played out in this model, such as “What if Latinos had more (or fewer) Spanish-speaking PCPs in the community?” For this scenario, the authors found that if a governmental program boosted the proportion of Spanish-speaking PCPs to 50%, Latinos with LEP would have notably less care delay. The baseline number of PCPs that spoke Spanish in the sample was only 26%, demonstrating that language can be a serious barrier. In addition to increasing the number of PCPs that speak Spanish, Spanish-speaking patient navigators and community health workers can help alleviate disparities related to language and cultural barriers.

In another study, researchers investigated the number of people who self-report delaying medical care due to transportation barriers. Using longitudinal data from the National Health Interview Survey, the authors analyzed how transportation barriers changed over time and how responses differed by sociodemographic status. The analysis showed that transportation barriers have disproportionately impacted poor people and people with chronic illnesses. Individuals who were Hispanic, living below the Federal Poverty Line, Medicaid recipients, or had a disability were all groups more likely to report a transportation barrier. Current programs to aid vulnerable populations include transportation services for qualified disabled veterans and nonemergency transport services for Medicaid patients. However, the barriers identified in this study suggest that existing programs need to be improved, and more could be done to overcome transportation barriers.

Recent proposals in the federal government address issues in primary care funding, access, and delivery. The Congressional Budget Office (CBO) is reviewing the Primary Care and Health Workforce Expansion Act, brought forward by Senator Bernie Sanders (I-Vermont), chair of the Senate Health, Education, Labor and Pensions Committee. If passed, the Act would bring billions of dollars to the primary care landscape, primarily to community health centers and capital investments. Critics are concerned about the bill’s costs, and time will tell what impacts it may have on New Jersey and the United States.

Taylor Hughes is a graduate student in the Edward J. Bloustein School of Public Planning and Policy at Rutgers University and she is working towards a master’s degree in Public Policy. Taylor was also a part of the NJSPL’s 2023 Summer Internship Program.