Academic Medical Centers and Equity in Specialty Care Access for Children

Bisgaier, Joanna; Polsky, Daniel; Rhodes, Karin V.

doi:10.1001/archpediatrics.2011.1158

Cited by 27 publications

(5 citation statements)

References 36 publications

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“…This happened most often because they could not find a provider to accept public health insurance or because they could not afford the co-payment due at the time of service. Results of these interviews confirm those of previous studies that identified the lack of affordable and available care as major access barriers [27–29]. We found the most important factor to help parents overcome these access barriers was a continuous relationship with a health care provider or clinic site.…”

Section: Discussionsupporting

confidence: 84%

Understanding how low-income families prioritize elements of health care access for their children via the optimal care model

Angier

Gregg

Gold

et al. 2014

BMC Health Serv Res

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BackgroundInsurance coverage alone does not guarantee access to needed health care. Few studies have explored what “access” means to low-income families, nor have they examined how elements of access are prioritized when availability, affordability, and acceptability are not all achievable. Therefore, we explored low-income parents’ perspectives on accessing health care.MethodsIn-depth interviews with a purposeful sample of 29 Oregon parents who responded to a previously administered statewide survey about health insurance. Transcribed interviews were analyzed by a multidisciplinary team using a standard iterative process.ResultsParents highlighted affordability and limited availability as barriers to care; a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children. We present a new conceptual model to explain these experiences accessing care with health insurance: the Optimal Care Model. The model shows a transition from optimal care to a breaking point where affordability becomes the driving factor, but the care is perceived as unacceptable because it is with an unknown provider.ConclusionsEven when covered by health insurance, low-income parents face barriers to accessing health care for their children. As the Affordable Care Act and other policies increase coverage options across the United States, many Americans may experience similar barriers and facilitators to health care access. The Optimal Care Model provides a useful construct for better understanding experiences that may be encountered when the newly insured attempt to access available, acceptable, and affordable health care services.

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Section: Discussionsupporting

confidence: 84%

Understanding how low-income families prioritize elements of health care access for their children via the optimal care model

Angier

Gregg

Gold

et al. 2014

BMC Health Serv Res

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“…Table S1 in Supplemental Material summarizes the study characteristics of the 34 articles included in this review. 16-49 In total, the 34 studies represented 21,601 calls to provider offices requesting an appointment for Medicaid and private insurance scenarios, of which 63% resulted in successful scheduling. Of 11,387 calls with private insurance, 80% of calls successfully led to appointments, while 45% of 10 214 calls with Medicaid resulted in none.…”

Section: Resultsmentioning

confidence: 99%

Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

Hsiang

Lukasiewicz

Gentry

et al. 2019

INQUIRY

113

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Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.

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“…6 Health care access barriers and communication experiences may contribute to disparities, 7 and are therefore essential to understand. Access to pediatric academic medical centers is especially critical due to the high concentration of subspecialists serving publicly insured children 8 ; yet, the size of these systems and the complexity of children's health problems may magnify language and cultural barriers. 9 Many pediatricians report feeling insufficiently prepared to care for children in immigrant families, 10 including those who speak Spanish.…”

mentioning

confidence: 99%

Spanish-Speaking Parents’ Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use

Flower

Wurzelmann

Tucker

et al. 2021

Academic Pediatrics

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Background and Objective Children of Spanish-speaking caregivers face multiple barriers to care in academic medical centers. This study identified barriers and facilitators of health care, and described use of health information technology in order to guide interventions and optimize services. Methods In-depth, audiotaped interviews were conducted with monolingual Spanish-speaking caregivers (N=28) of children receiving care in academic medical center clinics using a structured interview guide. Interviews were transcribed in Spanish, and key themes were identified using thematic analysis. Illustrative quotes for each theme were translated into English. Results Language-specific barriers included: arrival/registration occurring in English, lack of bilingual personnel, heavy reliance on interpreters, long wait times, and challenging phone communication. Non-language-specific barriers included: medical center size and complexity, distance to services, lack of convenient and coordinated appointments, missing work/school, and financial barriers including insurance coverage or lack of citizenship. Caregivers identified interpreters, bilingual physicians and staff, and written materials in Spanish as facilitators of care. Most caregivers had internet access and expressed interest in health information technology, including patient portals, to communicate about their children's health. Conclusions Caregivers of Spanish-speaking children encounter many language-specific barriers, which are compounded by non-language-specific barriers arising from complex health systems and social needs. Caregivers with limited resources described working hard to meet children's complex health care needs despite these barriers. Most caregivers had internet access and interest in patient portals. Academic medical centers may need multifaceted interventions that improve the availability of bilingual staff and interpreters and also address caregivers' social and informational needs.

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Academic Medical Centers and Equity in Specialty Care Access for Children

Cited by 27 publications

References 36 publications

Understanding how low-income families prioritize elements of health care access for their children via the optimal care model

Understanding how low-income families prioritize elements of health care access for their children via the optimal care model

Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

Spanish-Speaking Parents’ Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use

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