The city’s health department has released its Access to Health Care in Bexar County during COVID-19 report, a months-long survey published in September that shows how access to health care changed in San Antonio during the pandemic.
The San Antonio Metropolitan Health District commissioned the Health Collaborative, Community Information Now, University of Texas at San Antonio, C3 Health Information Exchange, and UT Health’s School of Public Health to conduct research from fall 2022 to spring 2023.
Collectively, the group was paid $200,000 from the ARPA Health Disparities grant for their work on the ground. The report gathered information through surveys, interviews and focus groups. Every zip code in Bexar County showed up in the surveys, said Junda Woo, medical director for Metro Health.
“The idea here was to get the local lens on these national problems locally so we could address them collectively,” Woo said.
Community health workers played a big part in getting the survey out and reaching communities who don’t have access to the internet. Most participants were more likely than average to live in low- to moderate-income households, and most were likely to be uninsured.
After the report, Metro Health will lead a follow-up survey and hold a community conversation in spring 2024 called “Opening Doors: Improving Access to Care.”
What changed during the pandemic
According to the report, drug related deaths rose more than 4% in 2021.
Woo said the type of drug associated with drug-related deaths in Bexar County was mostly meth, but there was also a growing number of fentanyl cases reported.
In 2021, there were 24.8 drug-related deaths per 100,000 men in Bexar County. There were 11.2 drug-related deaths per 100,000 women.
Suicide rates rose, too, particularly in men, by 5.9 more deaths per 100,000 people in 2021.
Although more pregnant women stayed enrolled in Medicaid during the pandemic due to continuous enrollment, early prenatal care — which affects if a woman will have a healthy pregnancy and early childhood outcomes — didn’t increase, Woo said.
“Early prenatal care has been a problem for a long time in our community,” she said. “We’ve got a geographical distribution of OBGYNs and midwives. There are large [pockets] of our community that don’t have easy access.”
COVID-19 worsened some health care barriers, according to the report, like difficulty getting an appointment, the rising cost of prescriptions and the fear of catching an illness at the doctor’s office. Other factors that existed before COVID included language barriers, transportation issues to get medical care, and discrimination or rude treatment at medical offices.
There were greater impacts on marginalized communities, Woo said: 70% of people living with a disability said the pandemic affected their ability to obtain medical supplies and access to health care. Another partner survey in the report found LGBTQ+ participants had difficulty accessing mental health services, especially Black, Hispanic and non-English speaking members of the LGBTQ+ community.
A major health care concern among Afghan refugees was dental problems, even more than the lack of health insurance in those populations, as well as the language barrier, a survey by the San Antonio Center for Refugee Services found.
Immunization among kindergarteners declined from 97% to 94% in 2021.
That change “may not seem like a lot, but the community immunity threshold to prevent measles outbreaks is estimated to be at 95%. This was in 2021, so we can hope that it’s better now,” Woo said. “For children, measles is fairly benign for most of them, but for in one in 1,000, it can result in encephalitis, hospitalization or worse.”
Effects of temporary federal aid
Some metrics actually improved during the COVID-19 pandemic, partially due to an influx of federal dollars dedicated to continuous Medicaid coverage for low-income groups.
Covid caused an increase of people staying on Medicaid coverage. So did telehealth reimbursements and ACA Marketplace subsidies, which increased San Antonians’ access to care. In fact, 34.9% of residents in Bexar County said receiving financial assistance with health care improved their access to health care.
According to the report, many recognized that health insurance, financial assistance with health care costs and disparate geographic barriers were “barriers to care” that originated prior to the pandemic and persisted throughout: “The relationship between public health and health care became more apparent during the pandemic.”
There was also an increased awareness of existing health care resources. Telehealth worked for some people, especially in mental health care, but others needed extra help.
More groups came together to bring health care into neighborhoods in San Antonio, including newly formed partnerships or organizations, for example, WellMed bringing COVID vaccines to the South Side, Woo said.
Although many Texans have been dropped from Medicaid due to the end of the public health emergency, Marketplace subsidies are continuing. Open enrollment for 2024 starts Nov. 1, and most people can get a plan with a subsidy, Woo said. Others can get a plan for as little as $10 a month.
San Antonians said language barriers continue to be an issue for them, especially for non-English and non-Spanish speakers. Transportation also remains a key barrier, and the mass exodus of health care workers leaving the field affected the quality of care.
Language barriers and transportation are issues that come up any time there’s an emerging infectious disease, Woo said. Metro Health clinics have someone available to translate 90% of the time, she estimated, and can hand out transportation vouchers.
The report also details Bexar County residents say they need support with medical debt or future medical costs, health insurance services or support, and technology consultancy services or support.
To address some of the issues in the report, Woo said the city should prioritize finding gaps in prenatal and maternal mental health care and should prioritize access to clinics with its transportation options.
“I can’t think of a single health condition where, once you start talking to patients, they don’t say transportation is an issue,” Woo said.
She also said the city can raise awareness about the Civil Rights Act of 1964, which says every person has a right to request an interpreter in a health care setting. The city should also share existing resources, like SACRD and OATS, she said, and educate clinicians on stigma-free, respectful care, especially for Black maternal health care and mental health care.
For the full report, click here.
