Individual Problems with Access to Health Care

In addition to system-related constraints on access to care, the elderly may experience individual or personal problems that affect their abilities to access health care resources. These problems can take several forms:

Physical Access Problems:

• Transportation and mobility problems.

Internal Constraints to Access Problems:

• Fear or distrust of health care providers;
• Feelings of poor self-esteem (i.e., they don't deserve the
  attention of others, or younger people deserve it more);
• Misunderstanding of one's rights or one's coverage;
• Culturally-based reservations about health care; and
• Lack of recognition of health care problem.

External Constraints to Access Problems:

• Institutional restrictions (nursing home personnel failing to recognize
  referral need);
• Family neglect or abuse, or patient is dependent on others to access care;
• Physician failure to refer appropriately, or to offer the most appropriate treatment;
• Inadequate supply of specialists (e.g., rural elderly);
• Can't afford long term care without selling house and/or using up economic resources;
• MCO denial of treatment or appropriate drugs;
• Insufficient coverage (out of pocket expenses burdensome); and
• Inadequate home-care services.