Access and System Navigation

In Orange County, residents with low socioeconomic status (SES) are more likely than higher SES groups to have access-related issues, such as no health insurance, an inability to afford medications, inadequate transportation to medical appointments, and a lack of recent health screenings. According to the 2020 American Community Survey, people identifying as Hispanic/Latino, American Indian/Alaska Native, and people of other races alone had the largest uninsured population (see graph below).

Uninsured Population by Race/Ethnicity in Orange County

Source: American Community Survey, 2016-2020.

Utilizing appropriate clinical and preventative services in a timely fashion can have important implications on the progression and treatment of many diseases. Those who receive treatment earlier have greater opportunity to prevent disease or detect disease during earlier, treatable stages while a delay of necessary care can lead to an increased risk in health complications.

Between 2018-2019, the proportion of Orange County residents who experience difficulty obtaining care is 11.2% compared to 12.7% for California.

Percent of Orange County Residents Who Delayed Care or Had Difficulty Obtaining Care

Source: California Health Interview Survey, 2003- 2019.

People Who Delayed Care or Had Difficult Obtaining Care by Age (2019)
Orange County

Source: California Health Interview Survey, 2018- 2019.

Orange County residents ages 25-44 were the most likely to have difficulty obtaining care or delay care. Those under the age of 17 were the most likely to obtain care. This may be due to the fact that majority of children and youth are covered by Medi-Cal or other insurance (see below).

Why is this important?

Health insurance for children is particularly important. To stay healthy, children require regular checkups, dental and vision care, and medical attention for illness and injury. Children with health insurance are more likely to have better health throughout their childhood and adolescence. They are more likely to receive required immunizations, fall ill less frequently, obtain necessary treatment when they do get sick, and perform better at school. Having health insurance lowers barriers to accessing care, which is likely to prevent the development of more serious illnesses. This is not only of benefit to the child but also helps lower overall family health costs.

The Healthy People 2030 national health target is to increase the proportion of children with health insurance to 100%. As of 2019, the health insurance rate for Orange County was 96.0% compared to 96.4% in California.

Children with Health Insurance (measurement period: 2017-2019)
Orange County

Source: American Community Survey, 2019.

Children with Health Insurance (measurement period: 2017-2019)
Orange County

Source: American Community Survey, 2019.

Why is this important?

Psychological distress can affect all aspects of our lives. It is important to recognize and address potential psychological issues before they become critical. Mental disorders are common across the United States, but only a fraction of those affected receive treatment. According to Sapien Lab’s report on mental health, 45% of individuals in the United States report having a clinical-level mental health problem and did not seek professional help in 2021. Persistent mental and emotional health problems should be evaluated and treated by a qualified professional.

Having and Receiving Care for Mental Health is Normal

Adults Needing and Receiving Behavioral Health Care Services (measurement period: 2007-2019)
Orange County

Source: California Health Interview Survey 2007-2019.

Adults Needing and Receiving Behavioral Health Care Services by Age (2019)
Orange County

Source: California Health Interview Survey 2018-2019.

Barriers associated with health care access include: 1) costs, 2) availability of services, 3) navigating the health care system and 4) lack of awareness and education about resources available in the community. In the 2022 Hoag Community Needs Assessment, 39% of interviewees indicated that health care access and delivery were the greatest health needs while 19% reported health care access to be a contributing factor to poor health outcomes in their community. Components of delivery of care include quality, transparency and cultural competence.

Cultural competency in health care means “delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors” (Tulane University, 2021). It is also an understanding of the impact that cultural differences can have on health care delivery. Cultural competence refers to meeting the needs of people with disabilities, individuals from diverse socioeconomic backgrounds, and members of the lesbian, gay, bisexual, transgender, queer (LGBTQ) community.

One of the sentiments shared by a community member articulated the vulnerability felt by patients who do not have access to culturally competent providers.

“…I have to consider how badly I need to go in for my annual exam. Do I want to go through this? If I feel healthy, I might be like, I don’t really want to deal with it. So, there’s a huge problem of just healthy LGBTQIA folks not getting their preventative care, because they don’t want to deal with it. So, it’s the access even though it’s accessible. I have great insurance, I have a good doctor, I have access, but it doesn't feel good. I don’t have a good rapport with my provider. So, it prevents me from going sometimes. So, there are the access problems. And I think it’s around cultural competency.”

In Orange County, an estimated 381,543 people live in an area that has a shortage of primary care providers. Availability of primary health care providers affects access to health care in the community. Based on the 2021 County Health Rankings, Orange County ranks 17 out of 58 California counties for access to clinical care providers. When compared to California’s ratio of population to health care providers, Orange County has a good ratio of access to primary care physicians (one doctor per 1,010 residents) and dentists (one dentist per 870 residents). The ratio of population to mental health providers, however, shows that Orange County has significantly fewer mental health providers than the state ratio, making access to mental health care more difficult for those needing services.