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Access to Healthcare

May 1986
June 1986 (revised)
May 1994 (revised)
December 1998 (revised)
March 2002 (revised)
November 2005 (revised)
November 2008 (revised)

Statement of the Issue

Hospitals have a long tradition of providing care to anyone who needs it. However, access to care is severely challenged by the lack of healthcare coverage for all individuals. According to “Cover the Uninsured,” a project of the Robert Wood Johnson Foundation, 46 million Americans, including 9 million children, are living without healthcare coverage. The problem of access to care is further exacerbated by the erosion of support for community-based resources that provide preventive services, primary care access and ongoing care for patients with chronic conditions. As a result, hospital emergency rooms continue to experience increased patient demand for services that might otherwise be better delivered in lower cost settings designed to offer continuity of care.

While healthcare executives remain committed to maintaining access to care regardless of the patient’s ability to pay, fulfilling that commitment strains resources and puts some organizations in financial peril. In the absence of a system for insuring all patients or other viable solutions, there will come a point at which the ability to provide access to all in need will be compromised.

As leaders within the community, healthcare executives are well positioned to actively participate in the effort to reach community consensus on how healthcare resources and needs should be balanced so access to care is preserved.

Policy Position

The American College of Healthcare Executives (ACHE) believes no person should be denied necessary healthcare services because of an inability to pay. Further, ACHE believes access to care is a shared responsibility of healthcare organizations as well as government programs and agencies, community groups, and the private insurance market. To this end, ACHE urges healthcare executives to lead the effort within their organizations and on behalf of the communities their organizations serve to address issues related to funding services for the uninsured and underinsured. Consistent with ACHE’s Code of Ethics and its policy statement, "Ethical Decision Making for Healthcare Executives," there is a responsibility to consider broader community and societal implications as well as individual and organizational impact when addressing issues such as those affecting access.

Leadership responsibilities for healthcare executives include, but are not limited to:

• Developing and communicating access-to-care policies within their organizations and to the community.



• Managing their organizations efficiently to help underwrite healthcare costs associated with uncompensated and undercompensated care.



• Collaborating with other healthcare providers in their community to develop shared approaches to ensure access to care.



• Encouraging and assisting trade and other professional associations to take proactive roles in access-to-care issues.



• Promoting shared leadership and funding responsibilities among government, healthcare organizations, employers, private insurers and consumers.



• Organizing grassroots advocacy efforts to secure needed funding from local, state and federal government bodies.



• Organizing or participating in local, state and regional initiatives to resolve access problems.



• Spearheading discussions with key decision makers (e.g., legislators) and key stakeholders (e.g., public agencies) to identify community health priorities so available resources can be allocated equitably and effectively.

An important role for healthcare executives has always been to translate social values into workable healthcare programs. In keeping with this role, healthcare executives have the opportunity to participate in public dialogue about new ways to finance and deliver healthcare so no one is denied care because of the inability to pay.

Approved by the Board of Governors of the American College of Healthcare Executives on November 10, 2008.