Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, 1303A Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
J Community Health. 2010 Jun;35(3):240-8. doi: 10.1007/s10900-010-9230-0.
Most proposals to improve access for uninsured adults focus on removing financial barriers to health care. Health services researchers have long recognized, however, that access to care is a multidimensional concept consisting of both financial and nonfinancial dimensions. While financial barriers faced by those without health insurance have been well-documented, it is not known to what degree nonfinancial barriers limit access for those without coverage. In this study we sought to identify the types and frequencies of nonfinancial access barriers faced by low-income uninsured adults, as well as determine how frequently nonfinancial barriers coexist with financial access barriers in this population. We conducted a telephone survey of 1,118 low-income uninsured adults in Alameda, California, Austin, Texas, and Southern Maine who had enrolled in local access programs funded through the Robert Wood Johnson Foundation's Communities in Charge initiative. Financial barriers were the most often cited barrier to access in each of the three groups, though nonfinancial barriers were often cited as well. Across all three populations, one-third to one-half of respondents with financial access barriers also cited one or more nonfinancial barriers as contributing to their problems accessing health care. Our results suggest that many uninsured adults face nonfinancial health care barriers in addition to their well-documented financial challenges. Health reform efforts must address both types of barriers in order to maximally improve access for the uninsured population.
大多数旨在改善无保险成年人获得医疗服务机会的提议都集中在消除医疗保健方面的经济障碍上。然而，卫生服务研究人员早就认识到，获得医疗服务是一个由经济和非经济因素组成的多维概念。虽然无保险者面临的经济障碍已经得到充分记录，但尚不清楚非经济障碍在多大程度上限制了无保险者获得医疗服务的机会。在这项研究中，我们试图确定低收入无保险成年人面临的非经济准入障碍的类型和频率，并确定在该人群中，非经济准入障碍与经济准入障碍共存的频率。我们对加利福尼亚州阿拉米达、德克萨斯州奥斯汀和缅因州南部的 1118 名低收入无保险成年人进行了电话调查，这些人参加了由罗伯特伍德约翰逊基金会的“社区负责倡议”资助的当地准入项目。在这三个群体中，经济准入障碍都是最常被提及的获得医疗服务的障碍，但非经济准入障碍也经常被提及。在所有三个群体中，有三分之一到一半的有经济准入障碍的受访者表示，一个或多个非经济障碍也对他们获得医疗保健造成了影响。我们的研究结果表明，许多无保险成年人除了面临众所周知的经济挑战外，还面临非经济的医疗保健障碍。医疗改革努力必须解决这两种类型的障碍，以最大限度地提高无保险人群的获得机会。
