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Access & bARRIERS to care

Access to quality preventive healthcare can catch potential health problems at their earliest stages, increase healthy behaviors, and ultimately prevent chronic illnesses before they begin.

 

Access to care can be limited by the number, geographic location and capacity of health care providers. It can also be limited by barriers like cost, stigma or fear,  lack of time, ability to access services in a language you speak, lack of transportation, and health insurance status, among others.

Access to providers

Access to primary care providers increases the likelihood that community members will have routine checkups and screenings, which can lead to finding and treating conditions before they become more severe and complicated.

California is organized into Medical Service Study Areas (MSSAs). SLO County has five MSSAs within its borders — 170, 171, 172, 173, and 174. One of those—MSSA 173—is designated as a Primary Care Physician shortage area, or an area without the recommended number of physicians, nurse practitioners, and physician assistants relative to the population. (See how the state calculates shortage areas.)

Additionally, in the southern part of SLO County, two MSSAs—MSSA 171& 172—qualify as areas with a shortage of mental health providers.

mEDICAL sERVICE STUDY AREAS (MSSA) Primary Care & Mental Health Shortages

Source: Let's Get Healthy California. Master Plan for Aging. Primary Care Shortage Map. Mental Health Shortage data. Accessed July 2023.

mEDICAL sERVICE STUDY AREAS (MSSA)
Medi-Cal enrollment and access to care

CenCal Health has been SLO County's Medi-Cal provider since 2008. 

CenCal/Medi-Cal Enrollment in SLO County
23.8%

of SLO County residents ar
enrolled in Medi-Cal
47.3%

of SLO County children, ages 0 to 5, are enrolled in Medi-Cal
CenCal members able to get needed care
83%

of CenCal members answered ‘Always’ or ‘Usually’ to being able to get needed care.
CenCal members able to get needed care Quickly
81%

of CenCal members answered ‘Always’ or ‘Usually’ to being able to get needed care quickly.

"Being denied by specialists when my doctor makes requests is hard. I can’t get better if I can’t seek help."

- SLO County resident

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bARRIERS TO cARE

Several variables affect a person's ability to access to care. This can include the number, geographic location and capacity of providers. It can also include other barriers, like the lack of time, ability to access services in a language you speak, lack of transportation, and health insurance status, among others.

Reasons for delaying care

Some of these barriers caused people to delay seeing a doctor, a specialist, or other health professional for care they felt they needed.  The most common reasons are noted below.

Of SLO County residents surveyed in the 2023 Community Health Survey, 40% of respondents answered that they had delayed medical in the past 12 months, with responses higher among those under the age of 65 (51%), Spanish-Speakers (52%) and people experiencing homelessness (93%).

Delayed medical care in the past 12 months
40%

of SLO County residents surveyed delayed medical care in the past 12 months
Reason for Delay of Medical care (%)

Surveyed residents noted that they 'Couldn't get an appointment, or it was too long to wait' as their primary reason for delay (28%). For those who took the survey in Spanish, 'Too expensive, or worried about cost' was the most common reason individuals delayed medical care (21%) (n=219). For people experiencing homelessness, 'Worried what other people will think (stigma) if I get this care' was the primary reason for delay (28%) (n=136).

"My physician recently left and I was shocked at how difficult it is to replace her. Waiting periods of over a year to have a new patient appointment with MD's, DO's and even NP's."

- SLO County resident

Delayed Mental Health care in the past 12 months

Of SLO County residents surveyed in the 2023 Community Health Survey, 32% of respondents answered that they had delayed mental health care in the past 12 months, with responses higher among those under the age of 65 (40%), Spanish-Speakers (37%) and people experiencing homelessness (92%).

32%

of SLO County residents surveyed delayed mental health care in the past 12 months
Reason for Delay of mental health care (%)

Surveyed residents noted that they 'Couldn't find a provider who accepted new patients' as their primary reason for delay (17%).

"Considero que la salud en esta pais no deberia ser un privelegio deberia ser una necesidad para la poblacion.  /  I believe that health in this country should not be a privilege, it should be a necessity for the population."

- SLO County resident

Delayed Dental care in the past 12 months

Of SLO County residents surveyed in the 2023 Community Health Survey, 33% of respondents answered that they had delayed dental care in the past 12 months, with responses higher among those under the age of 65 (44%), Spanish-Speakers (51%) and people experiencing homelessness (94%).

33%

of SLO County residents surveyed delayed dental care in the past 12 months
Reason for Delay of Dental care (%)

Surveyed residents noted that care was 'Too expensive' as their primary reason for delay (28%).

"No hay doctores o dentistas aceptando nuevos pacientes y los que aceptan te dan citas hasta en 6-8 meses.” / “There are no doctors or dentists accepting new patients and those that accept you give you appointments in 6-8 months."

- SLO County resident

CAREGIVING & SUPPORT

Many older adults struggle to find care and supports as they age. The county's older adult population is higher than the state's, making long-term care even more important.

In the 2022 Needs Assessment Report from the Area Agency on Aging, respondents identified home repair, housekeeping/shopping, finding friends and social activities, and understanding Medicare as areas where they need the most help now. More than a third of seniors cite “don't know who to ask” as their top reason for difficulty in getting help.

"We need quality places for assisted living and long-term care.  Who can afford $8K/month?  Now my retirement is caring for elderly parents that have nowhere to go that they can even come close to affording."

- SLO County resident

Informal Caregiving

Currently, aside from limited hospital, hospice, and behavioral health services, there are few caregiving options for older adults in SLO County. As a result, caregiving predominately falls to family and friends who act as informal caregivers.  More than 1 in 5 Americans (21.3%) have acted as caregivers at some point in the past year, meaning they have provided care to an adult or child with special needs. 

 

These informal caregivers dedicate countless hours to caregiving, many citing impacts to their personal finances (45%) and their own health (23%) due to the role. 

Hours informal caregivers provide each week
23.7
hours each week
Source: National Alliance for Caregiving (NAC) and AARP. Caregiving in the U.S. 2020.

“Older adults and adults with disabilities are often stretched thin financially. They’ve cut back on spending and even borrowed money but are still struggling to afford housing and food. For many, paying for any amount of caregiving help is out of reach.”

 

- Kathryn Kietzman, PhD

Director of Health Equity, UCLA CHPR

Image by Matt Bennett

To help address the issue, an informal working group of SLO County residents developed a short-list of priority items for local action. See their report.

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