A Review: Understanding the Challenges of the Status Quo and Discovering How Medic All is Pioneering Transformative Solutions
In the past quarter century, the share of hospital beds at government-owned hospitals has declined by more than 40% [1], largely attributed to the trend of hospital conversions from public to private for-profit status. This change has been associated with a lasting efficiency improvement ranging from 2.9% to 4.9% [2], ultimately fueling an increase in average revenue per patient and a subsequent boost in profitability [3].
While these developments may seem promising for healthcare efficiency, the economically challenged often find themselves in a disadvantaged position due to healthcare privatization. Privatized healthcare systems often rely on a fee-for-service model, where patients are charged for individual treatments or services. For those with limited financial means, this fee-based structure can pose a significant financial barrier to accessing medical care [4]. Many might delay seeking necessary medical attention due to minimal available funds, leading to health deterioration and potential escalation of long-term medical costs. Privatization also diverts resources away from public healthcare systems, eroding and weakening their capacity to serve impoverished individuals effectively. Public hospitals and clinics, which typically cater to low-income populations, may face budget cuts or closure due to competition from private facilities, leading to reduced access to affordable healthcare services [5]. As a result, many using public healthcare face disruptions in their preferred providers, longer travel distances to access medical facilities, and extended waiting times for treatment [6].
Innovative technologies such as telemedicine have emerged in recent years, offering convenience and new opportunities for healthcare delivery. However, such capabilities often remain inaccessible to those who lack access to private healthcare services. The American Journal of Preventive Medicine reports that patients in counties with low poverty levels had about 48 telehealth visits per 10,000 people versus 15 per 10,000 in high-poverty areas [7]. This stark disparity highlights how technology-driven advancements in healthcare are not yet benefiting the most vulnerable and underserved populations.
The increasingly privatized nature of healthcare has contributed to an uneven distribution of resources, perpetuating health disparities and disrupting health equity. For many financially challenged individuals, limited access to comprehensive healthcare, preventive services, and specialized treatments further exacerbates their already vulnerable health conditions, as evidenced by a 25-year lower life expectancy and a 22% higher hospitalization rate for those in poverty [8]. This disparity in access to quality healthcare reinforces the cycle of inequality and hampers efforts to improve health outcomes for marginalized communities.
Individuals unable to utilize private healthcare generally turn to free clinics or Medicaid as primary sources of medical guidance. However, there are numerous barriers to the effective use of both avenues, leaving many incapable of resolving health problems with quick and immediate prognoses. Many receive a marginal amount of care, or more frequently do not take the first step in receiving healthcare.
Medicaid
As of 2021, Medicaid only covered ≈50% of adults in poverty [9]. One significant deterrent to the use of Medicaid is the lack of awareness and understanding of Medicaid's benefits and eligibility criteria. Many individuals might not be aware that they qualify for Medicaid or may be unwilling to navigate the application process. Similarly, administrative complexities in enrolling and maintaining Medicaid coverage can be time-consuming and require extensive documentation, making it difficult for individuals with limited resources and time to complete the necessary paperwork. In fact, procedural reasons account for 76% of individuals losing their Medicaid coverage [10]. In rural areas, the lack of participating providers may result in low-income individuals struggling to find accessible and timely medical care, undermining its effectiveness. As of September 2022, 65.6% of Primary Care Health Professional Shortage Areas (HPSAs) were located in rural areas [11]. Access to healthcare for impoverished undocumented citizens is also severely limited through Medicaid. The Deficit Reduction Act of 2005 requires documentation to receive Medicaid, barring undocumented individuals from receiving adequate healthcare [12].
Hospitals receive lower payments from patients with Medicaid compared to other insurance, often leading hospitals to limit the number of Medicaid patients they accept and leaving reduced options for individuals seeking care. Medicaid patients might face difficulties accessing preventive care services, such as routine check-ups and screenings, due to limited provider availability. This can lead to undiagnosed or untreated health conditions, resulting in poorer long-term health outcomes. Patients with chronic conditions or those requiring follow-up care might struggle to receive timely and consistent attention due to the challenges hospitals face in serving Medicaid patients. These disparities can exacerbate existing inequalities in health outcomes and access to quality care.
Constricting Coverage
Millions of residents are trapped in a health insurance coverage gap, where they earn too much to qualify for Medicaid, yet their income is insufficient to meet the threshold for financial assistance with private insurance. This gap leaves them in a precarious situation with few or no affordable health insurance options. Based on the current data from 41 states and the District of Columbia [10], over 3.8 million Medicaid enrollees have been disenrolled as of July 2023 because of changes in income coverage criteria, with over 150,000 of those individuals being from Kansas [13]. Until coverage is expanded to a wider population, millions of Americans lack adequate access to healthcare.
Free Clinics and FQHCs
Free clinics are private, nonprofit organizations that offer basic health care services to uninsured patients by licensed volunteer clinicians at little or no cost. The limited resources of free clinics pose challenges in delivering timely and efficient healthcare services, particularly when specific needs such as specialty care and interpreter services arise [14]. Limited transportation services also contribute to decreasing its use, as free clinics can be sparse, particularly in rural areas [11]. Low-income individuals residing in rural areas often face the risk of commuting long distances for healthcare checkups without the assurance that their health concerns will be sufficiently addressed. Consequently, many individuals may forgo seeking medical attention altogether, leading to adverse health outcomes [15]. Accordingly, Rural Americans are 50% more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts [16].
Federally Qualified Health Centers (FQHCs) are safety-net providers that are overseen by the Health Resources and Services Administration and are government-funded. These clinics are required to use a fee scale based on a patient's annual income and family size: fees range from $5 to $24 for patients whose income is at the poverty level to $87 for patients whose income is twice that level [17]. While these sliding scales offer a lower price than the average $50 physician visit [18], the high cost still dissuades over 40% of individuals from utilizing FQHCs [19].
In a nationwide survey conducted by Medic All, many healthcare professionals (HCP) voiced their desire to volunteer, but inability to do so due to long hours, lack of flexibility, and licensing requirements. Many free clinics require HCP to dedicate full days to volunteering, a commitment many cannot make with heavy workloads. Moreover, volunteering opportunities are often unavailable to students, despite it being a crucial period for them to learn and gain practical experience. Similarly, many volunteering opportunities are limited to physicians, preventing nurses, PAs, MAs, and other supportive roles from volunteering.
Each of these challenges also hinders the ability to maintain continuity of care for patients after a single day of volunteering. With limited availability and intermittent volunteering opportunities, it becomes challenging for HCP to establish a lasting connection with patients and provide ongoing support and follow-up care. Continuity of care is essential for fostering trust, understanding patient needs, and effectively managing chronic conditions or complex medical issues. In traditional healthcare settings, regular visits and ongoing relationships between patients and providers facilitates continuity of care. However, the nature of volunteering, especially when limited to brief periods, poses a barrier to achieving this level of patient-provider relationship.
Health equity is the attainment of the highest level of health for all people [20], ensuring that all individuals have full and equal access to opportunities that enable them to lead healthy lives. This includes addressing and alleviating the consequences of obstacles to adequate healthcare, including lack of access to good jobs with fair pay, quality education, housing, safe environments, and healthcare. As an organization providing free telemedical consultations, Medic All endeavors to make substantial strides in promoting health equity, reinforcing the idea that access to healthcare is a right, not a privilege. By striving to make healthcare more equitable, Medic All contributes to a world where everyone, regardless of their background or circumstances, has the opportunity to achieve their full health potential.
A critical obstacle to patient engagement lies not in retention but in the initiation of the first interaction. Impoverished individuals face a mountain of impediments, including geographical, documental, financial, and linguistic barriers, hindering them from establishing this crucial interaction and accessing long-term care. Medic All leverages telemedicine to eliminate such barriers, creating a positive and accessible first interaction that serves as the foundation for long-term patient retention. Whether patients choose Medic All or traditional healthcare systems, our goal is to empower them to make informed decisions about their health and well-being, ensuring that they receive the necessary healthcare services they deserve.
Medic All's mission is to eliminate barriers to healthcare by offering a seamless and cost-free pathway to affordable, accommodative, accessible, and inclusive healthcare.
Affordability
Medic All offers services to individuals with an income 200% below the poverty line with or without insurance. This criterion allows Medic All users to receive the quality of care offered through privatized health care without requiring them to pay for the consultation or have insurance. This criteria also allows individuals to overcome the gap formed by making too much to qualify for Medicaid, yet not enough to afford privatized healthcare. Often, individuals have to repeat their health history with every new doctor they see. Because Medic All maintains and refers to patient history across consultations, our service provides a more personalized and continuous care.
Accessibility
By eradicating initial obstacles through telemedicine, Medic All empowers patients to feel confident and reassured that quality care is within reach. During the pivotal first encounter, patients are heard, valued, and well-cared for, which fosters trust and facilitates routine healthcare interactions.[21] These factors contribute to patient satisfaction, a key driver of retention.[22] Significantly, successful first consultation with high patient satisfaction increases the likelihood of retention by nearly 67%.[23] Patients living in remote or rural areas, where free healthcare facilities are sparse or distant, can access medical consultations without needing to travel. Moreover, patients with limited access to reliable transportation can receive healthcare consultations from their own homes, again eliminating the need for travel. Users are much more likely to be willing to travel to receive medication or conduct tests in future visits after such a convenient and successful first interaction.
Accommodation
For people who work long hours or irregular shifts, finding time for a doctor's appointment can be challenging. Such restrictions are exacerbated when patients only receive treatment from free clinics, which generally have even more limited hours. Medic All's telemedicine approach allows these individuals to seek healthcare outside of traditional office hours. Moreover, the “Request a Time” feature further expands the convenience of healthcare. Long waiting times can also be a significant deterrent in seeking healthcare. Medic All's telemedicine approach reduces these waiting times and increases healthcare efficiency by greatly reducing the likelihood of delays.
Inclusive Care
Language barriers cause nearly 25 million Spanish speakers to receive 35% to 42% less healthcare than other Americans.[24] The scarcity of translators and Spanish-fluent HCP heightens such barriers at free clinics. A telemedicine platform greatly increases the reach of such individuals and brings their services to populations that most require them. By offering telemedicine consultations that prioritize patient confidentiality and do not require proof of legal status, Medic All creates a safe space for undocumented citizens to seek medical help. This can ensure they receive timely and necessary medical advice without fear of their personal information being used against them, thereby improving their access to healthcare services.
By offering consultations in four critical areas - Mental Health, Symptom-based Care, General Health Check-ups, and Fitness and Health - Medic All is ensuring a comprehensive and responsive healthcare service through the provision of free telemedical consultations.
Mental Health - Breaking Down Barriers
Individuals with the lowest incomes in a community experience depression, anxiety, and other mental illnesses 1.5 to 3 times more than their wealthier counterparts.[25] With mental health issues on the rise globally that disproportionately affect those with the lowest incomes, Medic All’s Mental Health Consultations offer a safe and accessible platform for individuals to openly discuss their mental health concerns with professionals. This approach offers many real-world benefits for users, including guidance for reintegration into the workforce and options for effective coping strategies.
Symptom-based Care - Prioritizing Prompt Response
Symptom-based consultations offer a timely solution for individuals seeking immediate medical attention. This service has been shown to expedite the diagnostic process and facilitate early treatment, ultimately leading to improved health outcomes.
General Health Check-ups - Promoting Preventive Care
Through the provision of General Check-up Consultations, Medic All is promoting the importance of preventive care. This initiative has encouraged a considerable portion of the community to engage in regular health check-ups, leading to early detection of potential health issues and overall improvements in community health.
Fitness and Health Consultations - Guiding Lifestyle Choices
The prevalence of long-term conditions, including diabetes, chronic obstructive pulmonary disease, arthritis, and hypertension, is significantly greater in adults from lower socio-economic backgrounds.[26] In response to the increasing prevalence of lifestyle-related health issues, Medic All's Fitness and Health Consultations provide tailored advice on nutrition, exercise, and healthy habits. By offering advice specific to the available resources of users, Medic All can present practical steps to a healthier lifestyle.
Medic All conducted an extensive survey encompassing over 250 individuals residing in both rural and metropolitan areas of Kansas, all of whom were situated 200% below the poverty line. The survey achieved a commendable response rate of approximately 82%. Notably, the primary reason cited for not utilizing the platform was "Access to the Internet," shedding light on a significant barrier faced by this specific demographic in accessing healthcare services through digital means. Though technology is prevalent in such populations, with over 85% of families living below the poverty line having some kind of digital device, smartphone or tablet,[27] nearly 1 in 6 impoverished individuals lack Internet access.[28]
Medic All is partnered with various organizations that increase access to technology for low-income populations. Partnering with libraries and community neighborhood resource centers allows Medic All to provide Internet accessibility. In communities where such facilities do not exist, partnering with organizations that have mobile technology vehicles offers Internet accessibility. Medic All is also partnered with international organizations aiming to distribute computers and telehealth kits to low-income communities.
With Medic All, HCPs chose their volunteering availability in 20-minute slots, giving them the flexibility to volunteer at their convenience. Medic All implements a telehealth self-scheduling protocol, where patients schedule appointments based on the pre-populated availability of HCPs. The provider will be notified 24 hours prior in cases where their time slot was not filled. A critical barrier to efficient HCP volunteering specifically with telemedicine is the prevalence of no-show appointments. A conducted survey with clinics utilizing telemedicine in the private sector found that nearly 29% of all appointments were no-shows, compared to 18% in-person.[29] This number is likely to be much higher for impoverished-specific care, given the increased variability in lifestyle.15 To prevent wasted time for HCPs, Medic All implements an automated check-in with patients 24-48 hours prior to their meeting. The consultation only occurs if the patient confirms that they will be in attendance.
Another concern many HCPs had with volunteering, according to the Medic All survey, was the inability to maintain continuity of care. The vast majority of patients they encountered were ones they had never met before, as conjoining the provider and patient schedules became difficult. Because volunteering is as easy as 20 minutes in front of a computer screen for HCPs, finding a mutual time for the patient and provider becomes significantly easier. As a result, each HCP meets with the same patients, likening subsequent interactions to a normal, privatized clinic.
Given the increasing role of telemedicine in the healthcare industry, training future HCPs to have the skills necessary to communicate via online consultations has become increasingly important. Medic All makes volunteering for such students possible by creating a special workflow for healthcare-education institutions with our EHR. Students facilitate the initial consultation and decide for the patient, which is then approved or rejected by the supervising HCP for the student, allowing for students to have controlled autonomy with their care.
Liability:
“A healthcare professional can enter an agreement with the Secretary of Health and Environment to offer gratuitous care to a medically indigent person, and in return the physician will be considered an employee of the state for purposes of the Tort Claim Act, which provides certain immunity from Liability.”
“A volunteer of a non-profit or government entity is immune to liability if they acted in good faith and within the scope of their official functions and duties. Immunity does not apply if the injury is caused by intentional or malicious conduct or negligence.”
Specialized Care
Medic All only provides general care and later funnels to specialized care based on HCP’s diagnosis. As the number of regular patients grows, Medic All plans to use AI-assisted technology to recommend a specific HCP based on the patient’s intake form. This technology will further simplify a patient’s entry into healthcare systems, emboldening Medic All’s mission to lower barriers to entry.
National and International Growth
Medic All is currently limited to patients in rural and metro KS. As we grow and establish proof of concept, we will continue developing partnerships and resolving legal barriers to HCP volunteering in other states. Eventually, we hope to expand internationally, making free telemedicine consultations available to second and third-world countries. We have initiated discussions of growth in 4 other states and India.
Referral Program
A critical factor to this growth will be ensuring that Medic All has a substantial group of HCPs willing to volunteer. As we grow our database of HCPs, establishing a referral program to continue onboarding HCPs will become logical.
Revenue Source
Medic All currently operates under revenue from grants and donations. As we establish proof-of-concept and efficacy, we will look to sell licenses of Medic All to organizations and companies serving similar populations. White labeling in this manner will allow Medic All to continue expanding by hiring more employees, deepening marketing efforts, ameliorating technology infrastructure, and fulfilling increased operational costs.
App development
An app for Medic All could offer a personalized and on-the-go experience, enabling users to access services in real-time, receive notifications for appointments or medication reminders, and even access telemedicine consultations offline, which is beyond the capability of a traditional website. Additionally, with an app's ability to integrate with device-specific features, such as a camera, GPS, and biometric sensors, it can provide a more interactive and comprehensive patient experience, such as capturing images for consultations, mapping nearby pharmacies, or tracking health statistics.
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