The Waiting Game: Why Urban Residents Are Struggling Most to Access In-Network Care

Urban residents lead the way in delayed care and urgent care reliance — a wake-up call for how we define network adequacy.

Data says that mental picture might be, if not wrong, incomplete. Not that rural communities don’t have frustrations with access to care, but the group struggling the most appear to be the people in the heart of our biggest cities.

We wanted to know how people living in the country’s different geographies—urban, suburban, and rural—felt about the job their health plans were doing when providing access to providers and how easy it was to get care when they needed it.

To learn that, we partnered with the third-party platform Pollfish and surveyed 1,000 U.S. residents and asked them about, among other things, how easy it was for them to provide an in-network provider near, how long they typically waited for an appointment to be available, and what alternatives they used when needed care wasn’t readily available.

What we found was that urban dwellers are the most frustrated. While urban areas have a dense concentration of providers, they also have dense populations competing for those same appointment slots. Offices are overbooked, schedules are full, and the result is a growing frustration among members who can’t get in to see a doctor when they need to.

Across all geographies, nearly half of respondents say finding in-network care in their area is at least somewhat difficult, but urban residents top the list at 51%. And the consequences are real: almost 60% of urban respondents have delayed care at least occasionally because of appointment delays, and many are turning to urgent care to fill the gap.

For insurers and network managers, the message is clear: healthcare availability isn’t just about how many providers you have on paper—it’s about how quickly members can get in the door. Without action, members will go elsewhere, either to a competitor’s plan or to urgent care providers eager to position themselves as a primary care alternative. One proven way to bridge the gap? Expanding access through network rental.

Key Findings:

• Almost half of all Americans struggle to find in-network care near them.
• Nearly the same number have postponed care because of that struggle.
• More than half of both rural and urban respondents said their location puts them at a disadvantage for timely care.
• Nearly 70% said they’d consider switching health plans for better physician availability.
• Only 14% of respondents said their provider network has the capacity to handle demand in their area.
• 53% of urban respondents have turned to urgent care when their primary care physician isn’t available.

Urban Frustration Tops the List

The idea that living in a city makes healthcare easier is an assumption that doesn’t hold up to scrutiny. In our survey, nearly half of respondents—47%—said finding in-network care in their area is at least somewhat difficult. That includes 7% who said it’s very difficult, with too few options, and another 40% who said it’s somewhat difficult because of long waits or limited specialties.

Urban residents reported the most difficulty, with 51% saying in-network care is at least somewhat hard to find. Suburban residents had the lowest rate at 45%, though even that is high enough to signal a problem, and rural residents landed between the two.

Those difficulties don’t just mean frustration, they often mean delays. When asked if they had ever postponed care because they couldn’t find an in-network provider quickly, 13% said yes, frequently, and another 36% said yes, occasionally. That’s nearly half of all respondents. Among urban residents, it’s even worse: almost 58% have put off care at least occasionally because of scheduling delays.

It’s also worth noting that lower frustration levels in rural areas don’t necessarily mean members there are well served. In fact, it may reflect a kind of built-in tolerance for inconvenience that comes from living in places where longer drives and longer waits are part of daily life. If you’re used to driving thirty minutes to buy groceries or a couple of hours to reach the nearest airport, waiting weeks to see a doctor may not feel unusual. But healthcare isn’t always something that can wait. And when rural members finally do get an appointment, their options are often limited by the small number of available providers. With fewer specialists — and sometimes only one or two primary care offices in a wide radius—patients may have little choice but to take whatever appointment is offered, no matter how far away or how far into the future it is. A higher tolerance for delays doesn’t erase the risk, it just means those risks may be underreported, and the consequences can be even more severe when time-sensitive health needs collide with limited access.

When we asked if people feel their location puts them at a disadvantage for timely care, 55% of rural respondents and 52% of urban respondents said yes, compared to just 37% of suburban residents. These frustrations are fueling churn, or they could be: overall, 68% of respondents said they would consider switching health plans for better physician availability. That number spikes to 76% in urban areas, 66% in suburban areas, and 60% in rural areas.

In other words, for a significant portion of members—particularly those in our largest cities—the challenge isn’t whether there’s a provider nearby. It’s whether they can get in before their health issue can’t wait any longer. And for health plans, that gap between proximity and availability is becoming a key driver of dissatisfaction and a clear risk to retention.

The Real Bottleneck: Timely Appointments

As we’ve mentioned, when we looked deeper into the types of access issues people face, one stood out above all others: the ability to get an appointment when they need it.

We were curious about which typical struggles our survey respondents had experienced. The biggest, three times larger than any other issue, was the inability to get in to see a provider quickly. Fifty-seven percent of respondents said they’d dealt with the issue while only 16% had trouble finding a provider nearby.

Members are noticing that their health plans are failing to adapt to their needs. Three out of four respondents said they don’t believe their networks are fully tailored to their local needs. Only 14% said they think their provider network has enough capacity to handle the demand in their area. When nearly nine in ten people are open to or outright eager for an expanded network, it’s not just a “nice to have,” it’s a competitive necessity.

For insurers, this means evaluating adequacy through a new lens. It’s not enough to count providers; plans need to measure whether those providers can realistically see members in a timely manner. Network rental offers a fast way to add that capacity, especially in hot spots where demand consistently outpaces supply.

Urgent Care: Filling the Gap and Raising the Stakes

When members can’t get in to see their primary care provider, many head straight to urgent care. Nearly half of all respondents have done it, with urban residents leading the way at 53%. And while some use urgent care for minor emergencies, a significant share cite speed and convenience as their main reasons. Forty-two percent told us they go to urgent care because it’s faster, and with 90% saying it’s at least somewhat easy to find an in-network urgent care clinic, the path of least resistance is clear.

On one hand, urgent care provides a useful safety valve. On the other, it can be a competitor — and a growing one. Some urgent care operators are actively marketing themselves as a replacement for primary care, encouraging patients to see them for ongoing needs rather than episodic treatment.

For health plans, it’s a strategic risk. If members start viewing urgent care as their primary relationship, the value of your in-network PCP base erodes. Continuity of care suffers, costs may rise, and loyalty to the plan can weaken. The more urgent care becomes a habit, the harder it is to bring members back into the fold of coordinated, preventative care.

What This Means for Health Plans

The takeaway from this survey is simple but powerful: healthcare access isn’t just about having providers in the network—it’s about making sure those providers can actually see patients when they’re needed. In urban areas, that means tackling appointment bottlenecks. In rural areas, it may mean adding specialties or reducing travel burdens. In all areas, it means thinking critically about whether your network is truly delivering on the promise of timely, high-quality care.

Members have made it clear that they’re willing to switch plans for better access. They’re also showing that if they can’t get it from their PCP, they’ll get it elsewhere, and sometimes “elsewhere” is positioning itself as a full-time replacement for what your plan offers.

For providers, insurers, and network managers, the message is clear:

• Timely access is a loyalty driver. Delays in getting an appointment are one of the most common reasons members consider leaving a plan.
• Network adequacy must be redefined. Counting the number of providers isn’t enough; you have to measure appointment availability.
• Urban areas need just as much focus as rural ones. Bottlenecks in high-density markets can be just as damaging to satisfaction and retention as scarcity in remote areas.
• Urgent care is both a partner and a competitor. It can fill short-term gaps, but growing marketing from urgent care chains positions them as primary care replacements—a threat to coordinated care.
• Network rental is a fast, strategic fix. Partnering with established networks in targeted geographies can add appointment capacity, reduce urgent care reliance, and improve satisfaction without overhauling your entire plan design.

The Case for Network Rental

Network rental is a way to address these challenges without tearing up your existing contracts or rebuilding from scratch. By partnering with established networks in targeted areas, health plans can quickly expand provider availability, ease scheduling backlogs, and shore up member satisfaction.

More than just keeping members in-network, this can keep them engaged, loyal, and connected to the kind of coordinated care that leads to better outcomes and lower costs.

In a market where nearly 70% of people would consider switching plans for better physician availability, network rental is a way to protect market share, improve retention, and deliver the timely access members are demanding.

Conclusion

The story this data tells is one of unmet expectations. Members expect timely, accessible care, and when they don’t get it, they act. For urban residents, the problem is overbooked schedules. For rural members, it’s distance, limited choice, and fewer providers. For everyone, it’s a willingness to look for faster, easier options, even if that means leaving your plan or redefining what “primary care” means.

In today’s healthcare landscape, timely access isn’t just a member perk. It’s a competitive advantage, one that no plan can afford to overlook. Health plans that want to stay ahead of the curve will tackle this head-on, not by simply adding names to a directory, but by ensuring those names represent real, available access. Network rental offers a practical, scalable way to make that happen.