A recent article about healthcare affordability used a word that slowed us down.
Barriers.
The article was written for employers. It talked about rising costs, benefit decisions, and the difficulties employees can face when more of those costs move in their direction. All of that mattered. But the word kept pulling the conversation somewhere else.
We usually think of a healthcare barrier as something visible. A deductible. A bill. A provider who is not in the network. A form that needs to be completed before anything else can happen.
Those are real. There is another kind that rarely appears in a benefits document.
Tuesday…Not Tuesday in any special sense. Just a normal weekday that was already full before anyone woke up sick.
Picture someone looking for an appointment before work. They find one at 10:40 that morning.
Technically, care is available. Then the rest of the day enters the decision. The meeting at ten. The person who is already out. The school drop off that ran late. The jobsite that cannot be left without someone there. The hour it may take to drive across town, wait, be seen, and get back.
The appointment is still open on the screen.
The day is not.
We have gotten used to treating availability and access as though they mean the same thing. Maybe that made sense when a patient’s only question was whether a clinician had an opening. It feels less complete now.
An employee can have insurance. The network can include a primary care practice. The practice can have an appointment. Every piece can technically be in place, and the person can still decide they will deal with it later.
That decision is easy to misunderstand.
From a distance, it can look like someone is not engaged in their health. Up close, it may look more like someone protecting the rest of the day.
We keep returning to the moment before the appointment disappears.
Not because the person canceled it.
They never scheduled it.
Nothing happened that would appear in claims data. No visit, diagnosis, referral, or prescription. Just a person looking at an available time and deciding that today could not hold one more thing.
Healthcare has no record of that moment.
The employer probably does not either.
Work continues. For a while, anyway.
The concern may get better on its own. It may wait until the weekend. It may get worse, and the next decision happens at an urgent care center after work. Or the person keeps meaning to come back to it.
Ordinary days do not produce clean data.
That may be part of what makes access difficult to measure.
We can count appointments and claims. We can count emergency room visits, prescriptions, and missed workdays.
We cannot easily count the number of times someone considered getting care and decided the day had no room for it.
The article focused on affordability. We came away thinking about calendars.
That was not where we expected the conversation to go.
If an appointment exists but someone cannot make it fit into the day, was care actually available?
The 60%
Field Note No. 005
Field Notes from the Working Majority.