Missouri healthcare: Why access isn’t as simple as it sounds

Column by Rob Jones, director of Integrated Marketing Communications, University of Missouri Extension; Joe Kingsbury, assistant director, MU Office of Health Outreach, Policy & Education; Sarah Davis, maternal health specialist, MU College of Health Sciences; Chiquita Chanay, education director, Community Health Engagement and Outreach, MU Extension; Rachel Mutrux, director, Missouri Telehealth Network, MU School of Medicine.

Across the state, many residents do not have consistent access to healthcare. According to research from Washington University in St. Louis, one in 13 Missourians, including one in 10 rural Missourians, do not have health coverage at all. Among those who do, many still miss needed medical appointments each year, often for reasons that have little to do with their willingness to seek care.

People across Missouri recognize that healthcare needs to improve. And the first step is understanding what is putting pressure on the system.

Barriers to access

Access to healthcare is shaped by several factors that work together.

Cost

The cost of healthcare remains a major barrier. Even for those with insurance, out-of-pocket costs, deductibles and uncertainty about pricing can delay care. Preventive visits, follow-ups and prescriptions are often postponed when cost becomes a concern.

Availability

In some communities, especially rural areas, there are few providers and limited access to specialty care. According to the Missouri Office of Rural Health and Primary Care’s Medical Facilities Map, 41 rural Missouri counties do not have a hospital, forcing patients to travel long distances for services that are routine elsewhere.

That movement affects the entire system. When patients leave rural communities for care, urban hospitals and clinics absorb that demand. Wait times increase. Providers are stretched, and capacity becomes more limited.

At the same time, rural systems weaken as fewer patients are able to sustain local services. Over time, that can lead to reduced services or closures, making access even more difficult.

Getting there

Even when care is affordable and available, getting there can be a challenge.

Reliable transportation is a consistent barrier across Missouri. Distance, cost and availability all affect whether people can reach care. Transportation also influences access to food, physical activity and social connections.

Childcare can affect whether people can attend appointments. Many parents delay or skip care because they do not have someone to watch their children.

Work schedules also create challenges. Many services operate during standard business hours, when people are working. Taking time off is not always feasible.

These barriers are often discussed separately. But in practice, they overlap, and they shape decisions long before someone enters a clinic.

The role of MU Extension

Through the University of Missouri Office of Health Outreach, Policy & Education (HOPE), MU Extension partners with the MU School of Medicine, MU Sinclair School of Nursing and MU College of Health Sciences to make healthcare more accessible in the communities that need it most.

For example, the Rural Scholars Program prepares medical students to serve rural communities, strengthening the long-term healthcare workforce. Other HOPE programs, like Show-Me ECHO and Continuing Education for Health Professions, equip providers with additional training and access to specialist knowledge, allowing more care to be delivered locally.

MU Extension also supports the systems that affect whether people can access care.

Specialists provide continuing education to childcare providers and work with communities across the state to address the root causes of low childcare availability. Together, these programs increase availability and quality of childcare while strengthening support for childcare providers.

MU Extension leads broadband access programs around the state and telehealth programs that connect patients to providers and specialty care, reducing the need for travel.

Together, these efforts make it easier for Missourians to access care and support their health.

Shared systems require shared solutions

There has been meaningful progress in expanding access to healthcare. Still, gaps remain. Many residents still face challenges related to cost, availability and the ability to get to care.

In the same way that barriers to healthcare often overlap, solutions require collaboration across sectors. Higher education, transportation, childcare, telecommunications and workforce systems all play a role in whether care is available and accessible.

Healthcare access depends on how well rural and urban systems work together. When care can be delivered locally, patients can stay closer to home, which helps reduce demand on urban hospitals and clinics. At the same time, urban systems are essential for providing specialized care across the state. Strengthening connections through telehealth, provider training and regional coordination helps improve how care is delivered overall.

Improving access requires sustained investment at both local and state levels. Strengthening infrastructure, expanding capacity and supporting communities take long-term commitment. Continued collaboration, coordination and investment will be necessary to ensure that more Missourians can access the care they need.

Building systems that work

Barriers to healthcare are shaped by how systems are designed.

Cost, availability and the ability to get to care all influence whether Missourians receive the services they need. These challenges exist in both rural and urban communities, and the systems that serve them are closely connected.

When systems are aligned and supported, more Missourians can access care, stay healthy and stay engaged in their communities.