Access to care during COVID-19: A qualitative study of healthcare system resilience in San Antonio, Texas

Background: The COVID-19 pandemic challenged healthcare systems across the United States. It had distinct effects in rapidly growing cities like San Antonio, Texas. San Antonio, one of the fastest-expanding metropolitan areas, faces high rates of uninsured residents and a mix of urban and semi-rural healthcare landscapes. This makes it a valuable case for understanding health system responses to access challenges during public health crises. This qualitative study examined how healthcare system leaders, frontline providers, and policymakers in San Antonio navigated three major challenges during COVID-19: system-level disruptions in healthcare delivery, telehealth access, and health insurance coverage. Methods: = 20) and 12 key informant interviews. These were analyzed thematically using a grounded theory approach to identify barriers and evidence-based resolutions. Results: Participants identified three core challenges: First, disruptions in healthcare delivery due to workforce shortages, reduced preventive care access, and discharge delays. Second, barriers to telehealth access related to the digital divide and health literacy. Third, instability in health insurance coverage following the rollback of pandemic-era Medicaid protections. Participants also shared practice-based recommendations. These included standardized screening for social determinants of health (SDOH) with linked referrals to resources, culturally responsive food assistance programs, and hybrid care models that integrate telehealth with in-person care. Conclusion: This project shows that engaging local leadership and coordinating strategies can make systems more resilient. These actions improve healthcare access during public health crises and offer practical lessons for other urban healthcare systems.