Insurance + access ≠ health care: Typology of barriers to health care access for low-income families

Jennifer E. DeVoe, Alia Baez, Heather Angier, Lisa Krois, Christine Edlund, Patricia A. Carney

Research output: Contribution to journalArticle

134 Scopus citations

Abstract

PURPOSE: Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers. METHODS: A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries. RESULTS: Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. CONCLUSIONS: Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.

Original languageEnglish (US)
Pages (from-to)511-518
Number of pages8
JournalAnnals of family medicine
Volume5
Issue number6
DOIs
StatePublished - Nov 2007

Keywords

  • Access to health care
  • Child health
  • Insurance coverage
  • Medicaid
  • Primary health care

ASJC Scopus subject areas

  • Family Practice

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