Saluja Sonali, McCormick Danny, Cousineau Michael R, Morrison Janina, Shue Lisa, Joyner Kyle, Hochman Michael
The Gehr Family Center for Health Systems Science and Innovation, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts.
Health Equity. 2019 Aug 23;3(1):423-430. doi: 10.1089/heq.2019.0056. eCollection 2019.
Millions of people gained health care coverage in Los Angeles after the Affordable Care Act (ACA); however, challenges with obtaining and utilizing primary care still persist, particularly in the safety net. In this study, we explore barriers to accessing primary care services among safety-net patients in Los Angeles after Medicaid expansion and implementation of other programs for safety-net patients after the ACA. We conducted qualitative interviews, in Spanish and English, with 34 nonelderly adult patients in 1 of 3 insurance groups: Medicaid, MyHealthLA (a health care program for low-income undocumented individuals), or uninsured. We recruited participants from three sites in Los Angeles in 2017. We analyzed our interviews using a framework approach and included emerging concepts from participant responses. We identified seven themes regarding barriers to accessing primary care: understanding the concept of primary care, finding a primary care provider (PCP), switching PCPs, getting timely appointments, geography and transportation, perceived cost or coverage barriers, and preferring emergency or urgent care over primary care. Patients with Medicaid were more likely to report barriers compared with other groups. Uninsured patients were less likely to understand the concept of primary care. Patients with MyHealthLA noted getting timely appointments and cost of care to be significant barriers. Despite Medicaid and other coverage expansions for safety-net patients after the ACA, substantial barriers to accessing primary care persist. Addressing such barriers through the development of targeted interventions or broader policy solutions could improve access to primary care for safety-net patients in Los Angeles.
《平价医疗法案》（ACA）实施后，数百万洛杉矶居民获得了医保覆盖；然而，在获取和利用初级医疗服务方面仍存在挑战，在安全网体系中尤为如此。在本研究中，我们探讨了医疗补助扩大以及ACA实施后针对安全网患者的其他项目实施后，洛杉矶安全网患者获取初级医疗服务的障碍。我们用西班牙语和英语对34名非老年成年患者进行了定性访谈，这些患者分属三个保险组之一：医疗补助、“我的健康洛杉矶”（一项针对低收入无证人员的医疗保健项目）或未参保。2017年，我们从洛杉矶的三个地点招募了参与者。我们采用框架分析法对访谈进行分析，并纳入了参与者回答中出现的新观点。我们确定了获取初级医疗服务障碍的七个主题：理解初级医疗的概念、找到初级医疗服务提供者（PCP）、更换PCP、获得及时预约、地理位置和交通、感知到的成本或覆盖障碍，以及比起初级医疗更喜欢急诊或紧急护理。与其他组相比，参加医疗补助的患者更有可能报告存在障碍。未参保患者不太可能理解初级医疗的概念。参加“我的健康洛杉矶”项目的患者指出，获得及时预约和护理费用是重大障碍。尽管ACA实施后为安全网患者扩大了医疗补助及其他覆盖范围，但获取初级医疗服务的重大障碍依然存在。通过制定有针对性的干预措施或更广泛的政策解决方案来解决这些障碍，可能会改善洛杉矶安全网患者获得初级医疗服务的情况。
