Angier Heather, Gregg Jessica, Gold Rachel, Crawford Courtney, Davis Melinda, DeVoe Jennifer E
BMC Health Serv Res. 2014 Nov 19;14:585. doi: 10.1186/s12913-014-0585-2.
Insurance 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.
In-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.
Parents 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.
Even 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.
仅靠保险覆盖并不能保证获得所需的医疗保健服务。很少有研究探讨“获得医疗服务”对低收入家庭意味着什么，也没有研究在可及性、可负担性和可接受性无法全部实现时，如何对获得医疗服务的各个要素进行优先排序。因此，我们探讨了低收入父母对获得医疗保健服务的看法。
对29位俄勒冈州父母进行了有目的的深入访谈，这些父母回应了之前在全州范围内进行的一项关于医疗保险的调查。多学科团队使用标准的迭代过程对访谈记录进行了分析。
父母强调可负担性和有限的可及性是获得医疗服务的障碍；与医疗服务提供者建立持续的关系有助于他们克服这些障碍。父母还描述了他们在可负担性和可接受性之间做出的艰难决定，以便为孩子获得尽可能好的医疗服务。我们提出了一个新的概念模型来解释这些通过医疗保险获得医疗服务的经历：最佳医疗模型。该模型显示了从最佳医疗到一个临界点的转变，在这个临界点上，可负担性成为驱动因素，但由于医疗服务是由一个不熟悉的提供者提供的，所以被认为是不可接受的。
即使有医疗保险覆盖，低收入父母在为孩子获得医疗保健服务方面仍面临障碍。随着《平价医疗法案》和其他政策增加了美国各地的保险覆盖选择，许多美国人在获得医疗服务时可能会遇到类似的障碍和促进因素。最佳医疗模型为更好地理解新参保者在试图获得可用、可接受和可负担的医疗服务时可能遇到的经历提供了一个有用的框架。
