Patients who are uninsured or, for other reasons, seek care through county hospital systems can face long waits, and often they are then referred to university medical centers. County hospitals can be inflexible in restricting access based on residency, and access can be more difficult if a clear diagnosis has not been made. Fragmentation of care can result when clinic providers treat health complaints only on an as-needed basis, and the number of people who receive their medical care this way is increasing. Statewide, access for uninsured individuals to screening services is especially limited, and there is often a lack of follow-up of positive FOBTs by colonoscopy. Patients with fewer financial resources often have a variety of logistical issues that can also reduce their access to treatment.

Advanced colorectal cancer patients often need a whole spectrum of services as their cancer progresses, including more active and urgent palliative care. There are approximately 230 hospices in Texas, and while most of them can provide a nurse or social worker, they may not be able to deliver injectable medications to a patient who, for example, is unable to swallow, especially in areas remote from major cancer centers.