BARRIERS TO HEALTHCARE
in the Street Level Health Project communities
(by Kim Barstow, updated December 6, 2011)
Material or Tangible Barriers
1. No current/valid identification card with a photo
2. No proof of income (check stubs, etc.) because paid in cash or unemployed
3. No proof of address or residency (homeless, squatting, living with friends/relatives, bills and leases are
in other people’s names, no contact with official/primary renter, in a recovery/rehab home, etc.)
4. Lack of transportation (esp. if older or injured)
5. No phone to call and make appointments or receive calls from clinic/hospital
6. Frequent phone service interruptions and/or phone number changes due to no money for bill,
frequent moves and address changes; hard to be contacted, get followup or remember current address
7. Lack of childcare. Can’t or don’t want to take children to appts, but no $ or support for childcare.
Economic Barriers
1. No money for transportation
2. No money for registration, visit and medication fees/co-pays
3. Fear of ending up with a bill for services
4. Already have a bill (and are too embarrassed to go back, or think they won’t be seen, etc.)
5. Can’t afford to miss a day of work or potential work
6. In another city working (e.g. seasonal farm work in Central Valley) when they finally get a followup call
for an appointment.
Skills Barriers
1. Limited or no English spoken
2. Limited or no English OR other common language such as Spanish or Cantonese (e.g. Mam speakers)
3. Double interpretation (e.g. Karenni to Burmese to English) means more time, more potential confusion
4. Limited or no literacy. Shame or difficulty asking for help or revealing illiteracy
5. Unfamiliar with phone tree menu systems and/or automated answering rather than live phone help
6. Unfamiliar with transportation system (BART, bus, etc)
7. Unfamiliar with registration-type processes (providing paperwork/documents, filling out forms, having
DOB/address/phone number memorized, understanding and answering registration questions)
Self-Advocacy Barriers
1. Don’t know what questions to ask, what words to use to get the right help and services
2. Culturally used to accepting advice/info from healthcare providers without asking questions
3. Feel they don’t have the right to be “exigente” (demanding) because they are getting free or low-cost
services without giving anything in return
4. Don’t have the time and energy to be super persistent in calling, visiting, or hassling clinics/hospitals
for followup, which is often what it takes to access overworked public healthcare system
5. If told by staff that they cannot be seen, receive services, don’t qualify, need to pay extra, need to
bring different papers, etc., patients will leave without asking questions or advocating for themselves
6. Memory trouble (due to age, neurology problems, or other causes) makes it harder to self-advocate,
follow all steps in a process, remember the right papers and questions, keep appointments, etc.
7. Substance use and/or mental health issues compound challenges in following the multistep process,
making and keeping appointments, memory issues, discrimination at site, and ability to self-advocate
Street Level Health Project * 2501 International Blvd, Oakland CA 94601 * 510-533-9906
Cultural Barriers
1. Men are often particularly not used to and feel shameful about asking for help, assistance or support
2. Working and supporting one’s family is valued over self-care
3. Different ways of understanding illness/wellness that conflict with or don’t match Western medicine
4. Feel like the provider didn’t actually understand/address/treat the self-perceived or self-diagnosed
problem, so patient ignores, adds to or self-modifies any treatment given
5. Cultural trust in medications to solve illnesses or symptoms; if no medication is given the patient thinks
no useful medical care happened
Fear, Intimidation and Discomfort Barriers
1. Assuming they are not eligible for any social services as immigrants, esp. undocumented
2. Fear of immigration detention or deportation, esp. when many questions and papers are requested
3. Professional, dressed up, formal atmosphere of clinics/hospitals is often unwelcoming and intimidating
4. Unfriendly reception staff (phone and front desk)
5. Security guards at door – intimidating esp. if undocumented, unfriendly, don’t speak client’s language
6. Untrusting of new clinic, new doctors, new nurses who they have never met before and aren’t familiar
to them. (Says Sr. Martinez, “why would I go all the way up there to Highland Hospital on the bus to
talk with nurses I’ve never met before who don’t know me or my story when I feel comfortable and
trusting here at SLHP where I already know everyone and it’s just down the street?”)
7. Don’t like meeting a new doctor/nurse at every visit – want the continuity and trust of seeing the same
person repeatedly for their healthcare. Esp. when retelling hard, traumatic stories and circumstances
8. Don’t know the neighborhood of the clinic, unfamiliar people and streets are intimidating or scary
9. Racism and classism frequently encountered by clients in healthcare settings
Structural Barriers
1. Many-step process to get healthcare (find out if you’re eligible, call to get on waitlist, make appt. for
registration, go to reg. appt., make appt. with a doctor, go to separate places for lab and meds, etc.)
2. Most day laborers and many low-wage workers don’t have a steady schedule or appt.-based life. It’s
often very difficult to make and keep appointments as a day laborer, esp. far in the future
3. Patchwork of healthcare options means few straightforward referrals available – everything is a caseby-case basis which most providers don’t/can’t take the time for so referrals are unsuccessful
4. Receive healthcare from multiple providers at multiple clinics/hospitals due to patchwork system – no
coordination, communication between providers about care or follow-up
5. Respectful, thorough and in-depth service is extremely dependent on who you happen to meet with at
a clinic or hospital. Information about eligibility/services also inconsistent and depends who you talk to
6. Information about and potential eligibility for governmental health coverage plans (such as HealthPAC,
FamilyPACT, Medi-Cal) is often not given or shared with all people who might be eligible for it
7. Confusing and hard for patients (and healthcare workers!) that just one person needs HealthPAC for
primary care, FamilyPACT for sexual healthcare, and emergency Medi-Cal for hospital stays
8. Lack of social security card or legal residency severely limits eligibility for many programs and services
9. Long wait times for healthcare appointments in public clinics and hospitals, drastically decrease the
likelihood of getting services in extremely mobile/transient populations (e.g., day laborers, homeless)
10. Frequent falling out of care because healthcare coverage and/or clinic membership expired and client
wasn’t aware ahead of time or reminded to set up a renewal appt. Gaps in care can last several months
or longer, even with chronic illness, due to coverage expiring
11. Increasingly strict documentation requested (esp. for residency) to screen eligibility for 2014
healthcare coverage. No distinction made or explained about absolutely required documents (e.g.
photo ID) and “bring them if you have them” documents (e.g. passport or birth certificate)
Street Level Health Project * 2501 International Blvd, Oakland CA 94601 * 510-533-9906