Improving access to healthcare requires addressing the practical barriers that keep people from getting care: cost, transportation, workforce shortages, and the complexity of navigating the system itself. No single fix works in isolation. The most effective strategies tackle these barriers simultaneously, pairing insurance coverage with transportation services, community health workers, and programs that address basic needs like housing and food. Here’s what the evidence shows actually works.
Insurance Coverage Changes Who Gets Care
The most direct way to improve access is reducing the financial barrier. When states expanded Medicaid eligibility, newly eligible adults were 9.1 percentage points more likely to have a primary care visit and 6.9 percentage points more likely to see a specialist, compared to similar adults in states that didn’t expand. That’s a meaningful shift, especially for people who previously relied on emergency rooms for conditions that could have been managed earlier and more cheaply in a doctor’s office.
Globally, progress on financial protection has been slow but measurable. The share of the world’s population facing financial hardship from out-of-pocket health spending dropped from 34% in 2000 to 26% in 2022. The global service coverage index, which tracks whether people can actually get essential health services, rose from 54 to 71 over roughly the same period. But at current rates, projections show it will only reach 74 by 2030, with nearly a quarter of the global population still facing health-related financial hardship.
Transportation Is a Quiet Dealbreaker
People miss appointments because they can’t get there. Non-emergency medical transportation, often provided through Medicaid or community programs, is one of the most cost-effective interventions for keeping patients connected to care. It increases use of preventive and outpatient services while reducing reliance on expensive emergency visits.
For people with chronic conditions like kidney disease requiring regular dialysis, transportation assistance can be lifesaving in a literal sense. In interviews conducted for a federal report, patients described missing treatments and watching their health deteriorate before gaining access to ride services. Many said the biggest fear of losing transportation was that their conditions would go unmanaged and they might die. Beyond clinical outcomes, reliable rides restored a sense of independence. People no longer had to depend on family members or feel trapped at home.
Investments in public transit infrastructure have a similar effect at a larger scale, increasing both healthcare access and physical activity in the communities they serve.
Patient Navigators Cut Through Complexity
The healthcare system is difficult to navigate even for people with insurance and transportation. Patient navigator programs assign a trained person to help individuals schedule appointments, complete screenings, and follow through on referrals. The results are striking: out of 21 studies examining navigation’s effect on screening completion, 20 found an increase.
The specifics vary by type of screening. Navigation programs focused on colorectal cancer screening increased completion rates by 4% to 27%. For mammograms and other breast cancer screenings, the increase ranged from 19% to 37%. Lung cancer screening navigation boosted rates by about 15%. These aren’t small differences. A 37% increase in breast cancer screening in a community means cancers caught earlier, when treatment is simpler and survival rates are higher.
Navigators also reduce no-show rates for outpatient visits, typically by 5% to 20%. Of 23 studies looking at whether navigation helped patients attend follow-up appointments, 20 found improvement, either through higher completion rates or shorter wait times to get seen.
Community Health Workers Bridge the Gap
Community health workers are trusted members of the communities they serve, trained to connect people with health education, preventive care, and social services. They’re not doctors or nurses. They’re people who understand local culture and barriers, and who can meet residents where they are, sometimes literally, through home visits and neighborhood outreach.
The CDC’s Community Preventive Services Task Force recommends engaging community health workers based on strong evidence. Their effectiveness in preventing cardiovascular disease is particularly well documented: systematic reviews and studies with strong research designs have consistently found positive results, and the model has been replicated successfully across different settings. Community health workers are also recommended for health education, outreach, and helping people enroll in insurance or connect to services.
When paired with clinical teams, these workers reduce Medicaid spending and emergency department visits by catching problems early and ensuring people follow through on care plans. They’re especially effective in communities where language barriers, distrust of the medical system, or unfamiliarity with available resources keep people from seeking help.
Addressing Basic Needs Improves Health Outcomes
Healthcare access isn’t just about clinics and insurance cards. When someone is housing-insecure, food-insecure, or living in unsafe conditions, their health suffers in ways that no amount of doctor visits can fully address. The most effective access strategies recognize this and intervene upstream.
Permanent supportive housing programs, which pair affordable housing with voluntary services like case management, reduce emergency department visits, inpatient stays, and long-term care use. Home modification programs that address fall risks, lead paint, or asthma triggers in the home improve health while cutting costs. Food pharmacies and produce prescription programs, where doctors effectively “prescribe” healthy food, are linked to better blood sugar control and fewer hospitalizations. Cash transfer programs and tax credits like the Earned Income Tax Credit are associated with higher birth weights and lower infant mortality.
These interventions work because health is shaped by daily living conditions. A person with diabetes who can’t afford fresh food will struggle to manage their blood sugar no matter how often they see an endocrinologist.
Mobile Clinics Reach People Where They Are
Mobile health clinics bring services directly into underserved neighborhoods, removing the need for patients to travel. During the COVID-19 pandemic, a mobile clinic program in South Carolina conducted 260 visits across 149 unique sites, delivering over 12,000 vaccine doses to more than 8,500 people. Among those served, 44% were Black, and 44% were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to use the mobile clinics than other vaccination sites.
During periods when vaccines were in limited supply, mobile clinic use was highest in communities with the greatest barriers to traditional healthcare. This model extends well beyond vaccinations. Mobile units can provide blood pressure screenings, dental care, chronic disease management, and mental health services in areas that lack brick-and-mortar clinics.
Workforce Shortages Need Targeted Solutions
Access means little if there aren’t enough providers to deliver care. Shortages are most acute in rural areas and underserved urban communities. Federal programs try to steer providers toward these areas through financial incentives. The National Health Service Corps offers scholarships and loan repayment for clinicians who commit to practicing in shortage areas. The Nurse Corps Scholarship Program covers education costs in exchange for service at critical shortage facilities, and its loan repayment counterpart reimburses existing debt for nurses who serve in those settings or teach at nursing schools. A separate loan repayment program targets providers who treat substance use disorders.
These programs work, but they operate at a scale smaller than the problem demands. Expanding them would help, particularly as projections show growing gaps between the supply of primary care providers and the population’s needs.
Closing the Digital Divide
Telehealth expanded rapidly during the pandemic and remains a powerful tool for reaching people in areas with few providers. But it only works if patients have reliable internet. About 43% of low-income American families report struggling to pay for any internet access at all. In rural areas, available connections are often slow and expensive.
For many people, not being able to navigate online platforms means losing access to services that have increasingly moved digital: appointment scheduling, prescription refills, test results, and virtual visits with specialists who may be hours away by car. Broadband investment in underserved areas is, in practical terms, a healthcare access intervention. Without it, telehealth risks widening the gap it was supposed to close.