HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) In Brief TRACK Discussion: Submit a Comment TRACK Discussion: View Comments Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by DeVoe, J. E. Articles by Carney, P. A. Search for Related Content PubMed PubMed Citation Articles by DeVoe, J. E. Articles by Carney, P. A. Related Collections Children's health Vulnerable populations Mixed methods Health policy Access

Insurance + Access Health Care: Typology of Barriers to Health Care Access for Low-Income Families

¹ Oregon Health and Science University, Department of Family Medicine, Portland, Ore
² Oregon Health and Science University, School of Medicine, Portland, Ore
³ Oregon Health and Science University, Oregon Rural Practice-based Research Network, Portland, Ore
⁴ Office for Oregon Health Policy and Research, State of Oregon, Salem, Ore

CORRESPONDING AUTHOR: Jennifer E. DeVoe, MD, DPhil, Department of Family Medicine, Oregon Health and Science University, 3181 Sam Jackson Park Rd, Mailcode: FM, Portland, OR 97239, devoej{at}ohsu.edu

PURPOSE Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.

METHODS A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries.

RESULTS Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families.

CONCLUSIONS Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.

Key Words: Insurance coverage • access to health care • primary health care • Medicaid • child health

This article has been cited by other articles:

				K. C. Stange The Problem of Fragmentation and the Need for Integrative Solutions Ann. Fam. Med, March 1, 2009; 7(2): 100 - 103. [Full Text] [PDF]

				K. C. Stange In This Issue: Equity Global Theme Issue on Poverty and Human Development Ann. Fam. Med, November 1, 2007; 5(6): 482 - 483. [Full Text] [PDF]

TRACK Comments: