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Access to Healthcare

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

Statement of the Issue

At one time healthcare organizations could depend on income from public and private payors to underwrite a portion of the cost of care provided to the poor and uninsured. Although that source of income has eroded, the public expects healthcare organizations to maintain access to care regardless of the patient’s ability to pay. Without question, meeting this expectation strains resources and puts some organizations in financial peril. In the absence of renewed support or other viable solutions, there will come a point where our commitment to ensuring access to all in need will be compromised.

The American College of Healthcare Executives (ACHE) urges society to guard against these threats to access. 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 that access to care is preserved.

Policy Position

The American College of Healthcare Executives believes no person should be denied necessary healthcare services because of inability to pay. Further, ACHE believes access to care is a shared responsibility of healthcare organizations, regardless of ownership, 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 poor and underinsured. Consistent with ACHE’s Code of Ethics and policy statement on "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 on 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 task forces 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 that 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 7, 2005.