PBS News Hour

JOHN YANG: Preventative medical care can be a key tool in controlling high healthcare costs.

It can detect and treat early warning signs, help avoid costly emergency room visits, and contribute to better outcomes.

But nearly a third of Americans lack access to primary care services such as routine doctors checkups.

And 40% of U.S. adults say the financial burden of care has led them to delay going to the doctor or just not go at all.

We ask people around the country to tell us about the barriers they encounter when they try to go to the doctor for preventative care and primary care services.

ASHLEY GIL DE LAMADRID: I haven't been to a primary care doctor in maybe two or three years.

JOSEPH BAGDOVITZ: I just went to the doctor for a routine checkup with some blood tests, and I get this big bill in the mail a few weeks later.

And that experience by itself makes me less likely to go to the doctor because there's just so much uncertainty.

TOM BORROMEO: At first I was looking at Yelp reviews and health grade and things like that, and I realized you can't even be picky about that anymore.

You just got to be kind of grateful if you can find any doctor who says that they'll take on a new patient.

ASHLEY GIL DE LAMADRID: The new patient fee ranges, from my experience, between $300 and $450.

And yeah, insurance does not cover that at all in my experience.

KIMBERLY SLADE: I have a number of health problems, so I have attempted to go to the doctor on numerous occasions, every single one, and I'm talking seven or nine -- seven or eight, pardon me, doctors that I've had initial appointments with that have when I go back to reschedule, they are no longer in my network, no longer practicing.

CAROLINE MUSE: I have a lot of pain.

I have arthritis, like, everywhere.

And I finally had to go because I'm just in a lot of pain.

But then I went to get an X-ray and they said my insurance was invalid and I called them and they said it was valid.

So now, I have to wait another, whatever, two, three weeks to get an X-ray.

And so I'm still not being treated.

My hands are killing me and I work really hard, and so it's just really frustrating.

TOM BORROMEO: I needed to see a gastroenterologist about a year ago and I managed to get a 15 minutes call with one and I got charged $900 for that 15 minutes call.

And my insurance company, which was costing me quite a bit of money, would not pay most of it because they said I had a deductible for that.

So I was just really exasperated.

It's all very expensive and the care seems to be sort of inaccessible.

KIMBERLY SLADE: What's going to happen here shortly is I'm going to go to the ER, which is extraordinarily costly and unnecessary, but that's where we have a health care problem and the cost in this country.

Because when it's so difficult to see an actual doctor, people go to the ER, which is exponentially more expensive than just going to your individual doctor.

THERESA DURKIN: I feel that doctors are under a lot of pressure to see as many patients as possible, so they don't give the patient one-on-one attention.

I find that very frustrating as a patient advocate and as a patient myself.

So I just avoid it because it's very disheartening.

JOHN YANG: The voices of some of those who are frustrated with health care.

Dr. Maya Artandi is a clinical professor of primary care and population health at Stanford Medical School.

Dr. Artandi, the things that these people were citing, does that ring true to you?

Is that the sort of thing you hear?

DR. MAYA ARTANDI, Stanford Medical School: Yes, it definitely rings true to me.

It is very hard nowadays to get a primary care doctor.

Access is so minimal and it's very expensive.

JOHN YANG: Why is it hard to find a primary care doctor, not only getting to get an appointment, but sometimes finding one who's taking new patients is difficult?

DR. MAYA ARTANDI: It's a big problem.

We have a primary care crisis in this country.

Personally, I think that primary care is underappreciated, under a paid.

The young doctors don't want to be primary care doctors.

They want to be specialists.

And so we don't have enough primary care doctors.

The primary care doctors we have taken on an enormous amount of work with all the preventative health care, all the follow up visits, all the after-hour computer work, answering messages, and they get burned out.

JOHN YANG: During the pandemic, there were a lot of people who were afraid to go to see the doctor.

They were worried about sitting in the waiting room close to other people.

Have they gotten into the habit of not going to the doctor now?

DR. MAYA ARTANDI: There's still a certain amount of fear, but I think many people did not come to the doctor for three years and so they let their health problems lapse.

Unfortunately, those health problems then got worse.

The diabetes is less well controlled, the blood pressure is less well controlled and now everybody's trying to get in.

And it's frustrating, for us as providers as much as for patients.

JOHN YANG: You talked earlier about the lack of access to primary care physicians.

Is there one segment of the population or a type of patient who's more likely to lack access not be able to see a primary care physician?

DR. MAYA ARTANDI: It has a lot to do with insurances.

Patients who don't have good insurances have it even harder to get primary care doctor.

There are certain insurances that they are not taken by different clinics and those poor patients can't get access even harder for them.

JOHN YANG: And a lot of those patients end up treating the emergency room as their primary care physician.

Obviously, it's more expensive to do that, but what does that do to the system?

DR. MAYA ARTANDI: It is a big problem.

Those patients wait until they are seriously ill and then they do need to go to the emergency room because they are sick.

They need to get admitted to the hospital.

But we also have a lot of other patients who shouldn't come to the emergency room because they just need prescription refills or other things and the emergency rooms are overloaded.

Wait times are really high.

So that's not the good way to get primary care or preventative health care.

DR. MAYA ARTANDI: Has telehealth helped and does it have the possibility of helping solve this problem?

DR. MAYA ARTANDI: I'm a huge fan of telehealth because it does take away a lot of barriers patients have.

Patients don't need to find childcare care, elder care, take time off work because they can do those visits in their lunch break.

So, it is a really great thing to have.

There are other barriers.

Some patients, especially the elderly population, are not as savvy with video visits, so they don't feel comfortable with a telehealth visit.

But overall, I think telehealth is a really great addition to health care.

JOHN YANG: We've also seen the growth in urgent care centers, is that helping?

DR. MAYA ARTANDI: I personally work a lot in urgent care and I've seen so many patients.

And I hear from my patients, oh, I tried to make an appointment with my primary care doctor.

I can't get in.

So, now, as urgent care doctors, we start doing chronic disease management, not just urgent care anymore.

So, now I prescribe the diabetes medication, that blood pressure medication, because it's just too hard to get an appointment with primary care.

JOHN YANG: Another thing we heard from the people around the country talking about their experiences was frustration with insurance, which of course, the doctors, the providers have nothing to do with.

DR. MAYA ARTANDI: I'm as frustrated with insurance as the patients.

There's no transparency.

I order a test.

I don't know if it gets covered.

Every January, the insurance decides what medications they cover and what not.

I have patients who are in the same drug for 20 years, and suddenly the insurance doesn't cover it anymore.

And so, it would help if the insurances were more transparent about what they cover, what they don't cover.

JOHN YANG: What else can be done to take away these frustrations and help people go to the doctor more often or not be frustrated in going to the doctor?

DR. MAYA ARTANDI: I think it's important that everybody has a primary care doctor, because you don't want to wait until you really need a doctor, because then it will take 9, 10 months to see somebody.

So everybody should now make an appointment, check with the insurance, who's a network, and then just make an appointment, meet and greet so you have somebody and then follow up.

Do your preventative health care.

I know people think, oh, I'm healthy, it's not necessary.

But it's important to know if the blood pressure is at goal or not, because that way we then can prevent problems down the line.

JOHN YANG: Dr. Maya Artandi from Stanford Medical School, thank you very much.

DR. MAYA ARTANDI: Of course.