Disparities in Access to Gastrointestinal Care in the United States

Disparities in gastrointestinal (GI) care in the United States represent a major health burden, with GI diseases accounting for approximately $135 billion annually in direct medical expenditures. A pronounced geographic disparity exists, with over two-thirds of the 3,149 U.S. counties lacking any GI specialist. This results in an estimated 49-50 million Americans required to travel more than 25 miles for specialty care. For instance, states like Wyoming and Arizona report over 75% of residents are more than 25 miles from GI care, while states such as Alaska and North Dakota average only 1.8 gastroenterologists per 100,000 population. Socioeconomic inequities manifest as tangible deficits in care: a lack of insurance is associated with a 15-20% point gap in colorectal cancer (CRC) screening uptake. For hepatitis C virus (HCV) treatment, initiation within one year of diagnosis was 35% for privately insured patients but only 23% for Medicaid patients. In acute emergencies, uninsured patients face higher mortality in both upper GI bleeding (UGIB) and lower GI bleeding (LGIB). Targeted interventions show promise in mitigation: community health worker (CHW)-led programs have been shown to significantly increase CRC screening uptake. Patient navigation, often combined with mailed fecal immunochemical tests (FIT), has increased CRC screening completion by 7.3% points in safety-net populations. Telemedicine models can expand access, with video-based IBD care management programs requiring in-person evaluations in only ~ 1.3% of cases. Policy reforms, such as removing restrictive state Medicaid criteria for HCV therapy, have been shown to significantly increase treatment and narrow disparities. Continued focus on workforce incentives and data transparency remains critical to address these persistent, structurally rooted gaps.