Recent CommerceHealthcare® publications describe how various affordability and health insurance concerns complicate care and threaten the health of many individuals. This report extends that analysis by exploring the ongoing struggle to achieve equitable access to care. Serious disparities persist for several American socioeconomic segments.
This analysis reviews the enduring industry commitment to access and the current state of progress toward this vital goal. The larger context of patient experience is also discussed, followed by several finance and revenue cycle management (RCM) solutions that offer ways to mitigate today’s access problems.
Powerful continuing goal.
What is access?
Access has been defined as providing an individual “the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain, or to use healthcare services, and to actually have a need for services fulfilled.”[1] footnote 1 Ensuring that care is readily accessible to all who need it is a central mission of health systems, hospitals and practices. The federal Agency for Healthcare Research and Quality (AHRQ) counts access as one of five financial, operational and structural core elements of health equity (Figure 1).[2] footnote 2
Figure 1
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A shared provider objective.
Equitable access enjoys solid support among the nation’s providers. For 2025, 64% of healthcare executives see expanded emphasis on health equity, and 40% anticipate increased investments to achieve their goals.[3] footnote 3 Technology is one important priority. Leaders cite access as one of their top short and longer term drivers of digital advancement (Figure 2).[4] footnote 4 By 2030, addressing heightened concerns about health equity, affordability and social determinants will account for 20% of healthcare providers’ digital transformation IT investments.[5] footnote 5
Figure 2
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Major consumer issue as well.
Patients and consumers also place great emphasis on equitable access. More than half of respondents in a recent survey ranked “improving health care access and affordability” as one of their top three priorities among fifteen options, and one quarter rated access as their highest concern.[6] footnote 6 Only 28% of Americans believe that health insurance coverage “currently provides everyone with affordable access to health care, when it’s needed.”[7] footnote 7 Almost two-thirds consider it extremely or very important to “address racial disparities in health care and outcomes.”[8] footnote 8
The state of equity and access: disparities persist.
Full realization of access goals remains frustratingly elusive. As one report summarized, “too many people are underserved based on financial status, gender, race and ethnicity, sexual orientation, disability, location and age.”[9] footnote 9 A survey revealed that 38% of patients said some aspect of their identity created barriers to receiving the best possible care.[10] footnote 10 Income, insurance status and age led the factors, but several others were cited.
Income and access are clearly intertwined. In 2024, 34% of adults said they lack access to quality care due to cost, and the problem is significantly more elevated and growing at lower household income levels (Figure 3).[11] footnote 11 Lower income individuals also have a greater tendency to drop health insurance coverage, which can diminish access.[12] footnote 12
Figure 3
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Studies also show that financial disparities arise based on gender, ethnicity and other demographics. For example, women pay 18% more than men in annual out-of-pocket healthcare expenses, and from age 19 to 64, the average female pays more than a male of the same age, even excluding maternity costs.[13] footnote 13 Women are also 31% more likely than men to skip care due to cost.[14] footnote 14 Recent data reflects that Hispanic individuals lose access to dental insurance at twice the rate of their white non-Hispanic counterparts.[15] footnote 15
One avenue of access for many confronting affordability barriers is the Emergency Department (ED). Hospitals’ financial viability to maintain this pathway looks increasingly precarious. Reliance on the ED by the uninsured and underinsured results in a scenario in which Medicare and all other payment sources are “inadequate to cover the costs of providing care to those populations.”[16] footnote 16 The same analysis calculates that 20% of emergency physician fees have been unpaid in recent years.
Patient financial experience and access.
Access is a key element not only of equity, but also of patient experience. The access-experience relationship is bi-directional. Broad availability of care is fundamental to a patient-centric approach that breeds trust and loyalty. At the same time, a patient journey that minimizes both financial barriers and process friction fosters comprehensive access.
Patient experience has gained prominence in recent years. While they have met with mixed success, retail health competitors, such as Walmart and Amazon, have contributed to changing expectations of patients. Features like ease of interaction, clear communication, streamlined processing and expanded choice are the new hallmarks of accessible care.
Leaders are being advised to prioritize convenience and personalization as part of a “shift from transactional growth to creating access that delivers a compelling, value-driven experience.”[17] footnote 17 This approach is consistent with the accelerating long-run trend to consumers becoming “CEOs of their own health journeys.”[18] footnote 18
The financial aspect of healthcare has significant impact on the overall experience. A report on patient financial experience urges providers to address inaccurate estimates, surprise bills, lack of clarity and limited payments options that can hinder access “when patients defer care due to financial constraints.”[19] footnote 19
Financial tools for sustainable improved access.
Viewing solutions to the equitable access challenge through a financial lens highlights three top-level directions that organizations can take (Figure 4):
- Streamlining relevant operational processes, both back-office and patient-facing.
- Offering a robust patient financial assistance program.
- Maintaining overall financial strength to fund access expansion.
Figure 4
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Process automation.
Expediting processes and maintaining financial health are two important underpinnings to greater patient access. Existing operations are frequently a “rate limiter” for achieving new efficiencies, and health systems need to invest in “technology workflow optimization” and “closing gaps in data collection” to generate real improvements.[20] footnote 20
CommerceHealthcare® helps clients in these efforts with automation solutions in two key payments functions:
- Remittance management. Insurance and patient receivables are ripe areas for automation. Proven remittance processing systems create paperless, exception-based workflows in payments posting, unbundling aggregated remittances for proper system routing and reconciliation. This automation boosts staff productivity and speed-to-cash.
- Payables management. Organizations are realizing cost savings in supply chain management through centralized automation of high volume supplier payments, both scheduled and one-time and whether by credit card, EFT or check. Future enhanced gains are likely as artificial intelligence and e-payment technologies are applied to these automation systems.
Patient financing.
Substantial expansion of patient financing is crucial to equitable access. Articles by CommerceHealthcare® on “Addressing Affordability” and “The Strategic Impact of Patient Financing” detail programs that feature low- or zero-interest rate lines of credit for amounts up to $50,000 and adopt five characteristics:
- Expansive and flexible
- Cost-effective and efficient
- Transparent
- Consistent
- Technology-enabled
Investment funding.
Organizational cash flows and balance sheets will need to support technology and other investments essential to broad patient access. The capital project list includes facilities such as ambulatory networks that directly improve access.[21] footnote 21 A looming shortage of acute care beds is another investment pressure point. Significant declines in staffed hospital beds coupled with projected growth in hospitalizations are predicted to result in a nationwide adult bed shortage by 2032.[22] footnote 22 Commercial banks with significant healthcare experience can provide much-needed investment capital tailored to an organization’s specific financial profile.
Conclusion.
Advancing the cause of equitable patient access is critical. It will take concerted effort on many fronts, including financial. Payments automation, patient financing expansion and investment in facilities that add care access points are three financial strategies that strengthen capabilities to improve access. They merit current consideration.
CommerceHealthcare® solutions are provided by Commerce Bank.
[1]M. Jindal, K. Chaiyachati, V. Fung, S. Manson, and K. Mortensen, “Eliminating Health Care Inequities Through Strengthening Access to Care,” Health Services Research, June 2023.
[2]Agency for Healthcare Research and Quality, “Focusing on Health Equity in AHRQ's PCORTF Investments,” July 2023.
[3]Deloitte Center for Health Solutions, “Health Equity Remains a Business Imperative in the Life Sciences and Health Care Industries,” January 28, 2025.
[4]Huron Consulting, “Leaders Innovate to Tackle Top Challenges,” 2024.
[5]Gartner, “The Gartner Top Healthcare & Life Sciences Predictions for 2025,” January 8, 2025.
[6]Emory Rollins School of Public Health and Gallup, Public Health Priorities and the Pathway Forward, February 2025.
[7]PhRMA and Ipsos, Access Denied: Patients Speak Out on Insurance Barriers and the Need for Policy Change, October 2024.
[8]Ibid.
[9]Age Wave, The John A. Hartford Foundation, and Harris Poll, Meeting the Growing Demand for Age Friendly Care, September 17, 2024.
[10]PAN Foundation, State of Patient Access, March 2025.
[11]Gallup, “In U.S., Inability to Pay for Care, Medicine Hits New High,” April 2, 2025.
[12]Commonwealth Fund, “Paying for It: How Health Care Costs and Medical Debt are Making Americans Sicker and Poorer,” October 26, 2023.
[13]Deloitte, “Hiding in Plain Sight: The Health Care Gender Toll,” September 2023.
[14]Deloitte Center for Health Solutions, “What’s Causing U.S. Women to Skip or Delay Medical Care?” September 2024.
[15]CareQuest Institute for Oral Health, “Uninsured and in Need: 68.5 Million Lack Dental Insurance, More may be Coming,” August 2023.
[16]RAND, Strategies for Sustaining Emergency Care in the United States, April 7, 2025.
[17]Vizient and Kaufman Hall, “2025 Trends Report: Strategy is (Finally) Back in the Driver’s Seat,” December 12, 2024.
[18]Deloitte, “The Dawn of a New Health CEO,” 2024.
[19]Waystar, “Investment in Patient Financial Experience Key to Revenue Improvement,” April 2023.
[20]Oliver Wyman, “Making the EHR Part of the Solution, Not the Problem.”
[21]L. Dyrda, “Why Health System C-Suites are Nervous About 2030,” Becker’s Hospital Review, January 15, 2025.
[22]R. Leuchter, B. Delarmente, S. Vangala, Y. Tsugawa, and C. Sarkisian, “Health Care Staffing Shortages and Potential National Hospital Bed Shortage, JAMA Network Open, February 19, 2025.