Cousineau Michael R, Nascimento Lori Miller, Ponce Mabel
Department of Family Medicine and Preventive Medicine, University of Southern California, Keck School of Medicine, CA, USA.
Prog Community Health Partnersh. 2010 Winter;4(4):331-40. doi: 10.1353/cpr.2010.0014.
The complexity of the U.S. health care system has created many obstacles for individuals and families trying to gain access to health insurance and health care services. With a multitude of payers and provider organizations, health consumers must navigate complex arrangements that vary by payer, community, and employer.
This report describes the Health Consumer Alliance (HCA), an innovative collaboration of legal service organizations in California that combines individual assistance with broad advocacy work. Specifically, this paper highlights HCA's role in addressing systemic health care access issues that underlie many of the problems that health consumers face.
In a 5-year period, the HCA assisted more than 60,000 individuals with problems related to obtaining access to care and health insurance coverage. The HCA used the information gained from this individual assistance to address both local and statewide policy issues by pooling the technical and political resources of individual health consumer centers (HCC) and their partners.
The HCA has improved access to health care for many individuals beyond its client base by protecting indigent health services, expanding eligibility for public programs, and preserving the safety net for California's low-income population. The HCA model can be example of how information from individual consumer problems can be addressed at a broader level to reach and impact systemic change.
美国医疗保健系统的复杂性给试图获得医疗保险和医疗服务的个人及家庭造成了诸多障碍。由于存在众多支付方和医疗机构，医疗消费者必须应对因支付方、社区和雇主而异的复杂安排。
本报告介绍了健康消费者联盟（HCA），这是加利福尼亚州法律服务组织的一项创新合作，将个人援助与广泛的宣传工作相结合。具体而言，本文重点介绍了HCA在解决系统性医疗保健获取问题方面所发挥的作用，这些问题是医疗消费者面临的许多问题的根源。
在五年时间里，HCA为6万多名在获得医疗服务和医疗保险覆盖方面存在问题的个人提供了帮助。HCA利用从这种个人援助中获得的信息，通过整合各个健康消费者中心（HCC）及其合作伙伴的技术和政治资源，来解决地方和全州范围的政策问题。
通过保护贫困医疗服务、扩大公共项目的资格范围以及维护加利福尼亚州低收入人群的安全网，HCA改善了许多人（超出其客户群体）获得医疗保健的机会。HCA模式可以作为一个范例，说明如何在更广泛的层面上处理来自个人消费者问题的信息，以实现并影响系统性变革。
