Equitable Access to Care

GOAL

This chapter details all the goals and objectives to ensure that all Californians have access to quality resources and services that promote wellness and address preventive, diagnostic, treatment, survivorship, palliative, and end-of-life cancer care.

NARRATIVE

All Californians must have the opportunities to live healthily and have access to services that enable them to address a multitude of health issues related to cancer.

Equity is at the core of these, where equitable access requires that health and care resources exist and those in need of it have the knowledge and ability to get themselves to them.

This mandate encompasses financial, geographic, systemic, and cultural challenges that differentially affect certain segments of our population. Barriers to care exist but vary by group, location, and the systems currently in place.

A person's race, ethnicity, sexual orientation, gender identity, age/social generation, education, employment status, economic circumstances, geographic locality, and immigration status all impact both general wellness and care along the cancer continuum. For many, remaining uninsured or underinsured or not having dedicated primary provider results in a greater risk of later cancer diagnosis and early death.

The below objectives and strategies have been developed to ensure that every person can maintain their health and obtain quality services when needed.

Key elements of the plan include assessments and data collection so that barriers can be clearly identified and have measurable improvement, collaborations with partners (including non-profits, health insurers, and care providers), connecting communities with existing resources, educating professionals on barriers to care, and health policy advocacy.

An umbrella recommendation to support the objectives and associated strategies in this chapter is creating a repository (likely online) of free and low-cost services, possibly listed by county. This would include federally qualified health centers (FQHCs) and similar clinics.

• This repository would need to be continually updated and widely publicized as a tool available to the public. Though this would entail costs associated with maintaining a website, such a repository would go a long way in supporting those with obstacles to identifying and receiving cancer-related care in California, leading to a reduction of the overall cancer burden in the state.

Objective 1:

By 2025, increase equitable access to quality cancer-related preventive, diagnostic, treatment, palliative, and end-of-life care for the uninsured and underinsured.

Strategies

1. Establish or reinforce strategic partnerships with academic and community organizations to identify current barriers for under/uninsured to obtain care along the cancer continuum.

2. Work with community-based and non-profit organizations identified in strategy one to determine provider/systems-related barriers to providing screening and treatment for insured/uninsured.

3. Support network of Federally Qualified Health Centers and Look-alike clinics in increasing educational outreach to patients regarding no-cost screening.

4. Support advocacy efforts by Medical Associations at the local, regional and state level with regard to increasing access to screening and treatment services for under and uninsured.

5. Determine through Medicare and Medicaid databases how hospice is currently utilized by the under and uninsured and how to better capture this information.

6. Work with FQHCs and community organizations to identify patient-perceived cultural barriers to accessing end-of life care that can be addressed through public health programs.

Objective 2:

By 2025, reduce financial and geographical barriers to equitable cancer care for all Californians (insured and uninsured).

Strategies

1. Conduct an assessment to identify financial and geographic barriers to accessing cancer-related preventive, diagnostic, treatment, palliative care and end-of-life services.

2. Educate decision makers (legislators and health care plans) on the existing barriers to obtaining health plan coverage, including pharmacy benefits, to access cancer-care services.

3. Work with government agencies and health plans to identify those Health Professional Shortage Areas (HPSAs) in greatest need of cancer care services.

4. Identify financial assistance programs, charity care programs or supportive service organizations to assist with basic needs and medical cost resources.

5. Collaborate with regional transportation/transit planning initiatives to address access to cancer-care services.

6. Work with community organizations to engage community health workers, patient navigators and care coordinators to assist patients with overcoming barriers.

Objective 3:

By 2025, reduce systemic and cultural barriers to equitable cancer care for all Californians (insured and uninsured).

Strategies

1. Conduct an assessment to identify the systemic and cultural barriers to equitable cancer care for specific populations.

2. Develop cultural competency work plans (toolkits/roadmaps) to increase and improve the delivery of linguistically and culturally appropriate cancer care services.

3. Identify and work with stakeholders, government agencies and health plans to assist with cultural and language competencies in the cancer space and integrate cultural competencies.

4. Educate decision makers (legislators and health care plans) on how to reduce systemic and cultural barriers to cancer care for Californians.

5. Work with community organizations to engage community health workers, patient navigators and care coordinators to assist patients with overcoming systemic, cultural and language barriers.

6. Develop strategies to monitor and evaluate progress of reducing systematic and cultural barriers.