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

Abstract

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.

Waitlist management in a pediatric weight management clinic: implementing an orientation session

“…Additionally, some patients and families may wish to implement healthy lifestyle changes on their own while others do not consider obesity to be a problem [ 14 , 15 ]. Finally, common predictors of non-initiation with pediatric weight management include public insurance, race/ethnicity, and low-income status [ 15 , 16 ], which may actually point to competing priorities wherein families make healthcare decisions in a context of limited time and resources [ 17 ].…”

Two generations thrive: Bidirectional collaboration among researchers, practitioners, and parents to promote culturally responsive trauma research, practice, and policy.

“…In health care, economically disadvantaged children of color commonly experience a range of barriers to access to high quality, culturally responsive health care and are at greater risk of acute health problems and early risk factors for disease (Angier et al, 2014; Flores et al, 2005). In a sample of 2,608 children aged 4 to 35 months of age from the 2000 National Survey of Early Childhood Health, Latino and Black children were significantly less likely than White children to be insured, to be in excellent/very good health, and to be referred to specialists (Flores et al, 2005).…”

“…Parents of color also more commonly reported that their providers never or only sometimes understood their child rearing approach, and only 60% of Latino and 77% of Black parents would recommend their child’s provider, compared with 84% of White parents. Insurance coverage alone does not address these experiences of discrimination and limited access to culturally appropriate care (e.g., care that is responsive to preferences and needs that may vary by culture/ethnicity; Angier et al, 2014; Sexton et al, 2017).…”

A Qualitative Study of Two Oregon Family Medicine Clinics to Explain Parent and Child Healthcare Initiation and Engagement

“…Little is known about the reasons parents enter the healthcare system, or why some parents choose a healthcare “home” that is extended to their families, especially for low-income families with public health insurance (ie, CHIP and Medicaid). Previous conceptual models of healthcare access have not adequately described the relationship between healthcare utilization of parent and child ( 9 , 23 ). Thus, the goal of this study was to ask parents, whose children received care at the same family medicine clinic, their perspectives on how their choices around healthcare impacted their child's receipt of healthcare.…”