Oakland, California, like the nation, has experienced persistent racial, ethnic, income, and health disparities. These have been exacerbated by the coronavirus pandemic, which first took hold in mid-March 2020. Pandemic-induced shutdowns caused major disruptions in the nation’s critical infrastructure, social support services, and health care system. As a result, many were unable to access needed preventive care services.

This Urban Institute project sought to better understand whether and how the pandemic impacted access to and utilization of preventive health care in Oakland, particularly among communities that have historically lacked access to high-quality health care services.

Why this matters

Access to preventive care services is a critical and proven health intervention for reducing health disparities, improving quality of life, and enhancing treatment outcomes. Understanding how and why access was limited during the COVID-19 pandemic can allow policymakers to institute the reforms and programs needed to ensure that all communities, regardless of circumstance, can obtain preventive care.

What we found

• Patterns of care seeking changed: providers saw a sharp decrease in the uptake of preventive care services and a greater demand for COVID-19-related clinical care. When providers did catch up with preventive care appointments, they found a greater prevalence of mental health concerns among their clientele.
• Pandemic-induced changes strengthened the barriers that keep patients from obtaining preventive care, namely finding adequate child care and transportation, job loss and subsequent health insurance loss, and food insecurity. Community-based health organizations remained critical in connecting patients to needed resources and programs.
• Telehealth proved crucial for continuing to provide health services to patients amid pandemic restrictions. Telehealth allowed providers to come up with innovative ways to address patients’ concerns and increased overall access to health services, but barriers remained for patients who lacked a stable Internet connection or for patients who were not fluent in English.
• The ability to pivot quickly and efficiently proved a key requirement for community health organizations to meet changing patient needs during the pandemic. Providers and community-based leaders noted that inflexible funding often inhibited these organizations from shifting as quickly as they desired.

From interviews and focus groups, we concluded that, as the pandemic continues, virtual health care delivery, trusting patient-provider relationships, nimble operations, and special attention to relationship building and nonjudgmental care will be essential for adequately meeting the needs of patients.

How we did it

The data for this report came from qualitative interviews and focus groups. We interviewed key stakeholders, clinical providers, social service workers, and patients. Interview guides, procedures, and findings were reviewed by a community advisory board comprised of those who had intimate knowledge of local and systems-level issues and needs.