1. Introduction: Health Care Access in America and the Formal-Informal Hybrid Health Care System

Background: Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Knowing more about the experiences of African American Veterans who regularly experience health care access challenges may be an important step toward equitable, coordinated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination.Design: We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016.Participants and Setting: Veterans living in South Los Angeles, CaliforniaMain Outcome Measures: Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodology to identify emergent themes.Results: 12 Veterans and 3 family members of Veterans participated in one or more engagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experiences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services.Conclusions: Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local community organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Veterans.Ethn Dis. 2018;28(Suppl 2):475-484; doi:10.18865/ed.28.S2.475.

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Navigating the health-care system in community: Perspectives from Asian immigrant parents of children with special health-care needs

Journal of Child Health Care ◽

10.1177/1367493517753084 ◽

2018 ◽

Vol 22 (2) ◽

pp. 251-268 ◽

Cited By ~ 6

Author(s):

Esther Son ◽

Nechama Sammet Moring ◽

Leah Igdalsky ◽

Susan L Parish

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Access ◽

Immigrant Parents ◽

Care Needs ◽

Asian Immigrant ◽

Special Health Care ◽

Care Access ◽

Special Health ◽

Care System

Children with special health-care needs (CSHCNs) face notable barriers to health-care access and to receiving quality and family-centered care, despite higher health-care utilization rates. Within the population of CSHCNs, there are significant inequities in health-care quality impacting immigrants who have migrated to the United States. However, little is known about the experiences and needs of Asian immigrant families who have CSHCNs. This study aimed to explore how Asian immigrant parents of CSHCNs view their child’s health-care access, quality, and utilization. We conducted semi-structured qualitative interviews with 22 Vietnamese- and Cantonese-speaking parents of CSHCNs. Participants were recruited through community partners. Interviews were transcribed, translated, and coded using content analysis. Participants were generally satisfied with their children’s care and had strong relationships with their primary care doctors who were often culturally ‘matched’. However, participants experienced several important and culturally specific barriers, including gaps in their understanding of the health-care system, language barriers, and a sense of alienation. Parents frequently turned to informal and community supports for assistance in navigating the US health-care system. Further research to understand the drivers of health disparities and policy level solutions is warranted.

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Assessing Health-Care System Performance against the Four Core Aims of Health-Care Policy

Health Care as a Right of Citizenship ◽

10.7312/columbia/9780231170130.003.0007 ◽

2017 ◽

pp. 202-236

Author(s):

Gunnar Almgren

Keyword(s):

Public Health ◽

Health Care ◽

Health Care System ◽

Health Care Access ◽

System Performance ◽

Health Care Policy ◽

Care Policy ◽

Access And Quality ◽

Risk Protection ◽

Care System

Previous chapters have provided the historical context and the justification for a set of four core aims of health care policy in light of the requisites of citizenship in a democratic society, and then the basic structure of a reformed national health care system designed to achieve those core aims. Briefly stated, the four core policy aims include: comprehensive health insurance coverage with adequate and equal risk protection, the amelioration of disparities in health care access and quality, equitable comprehensive care and public health investments, and compensatory investments in health care services and public health infrastructure for groups adversely affected by health disparities. This chapter illuminates the major dimensions of health care system performance that are most closely linked to these core policy aims, the range of health care system measures specific to each dimension of performance, and those that appear optimal in light of validity and the pragmatics of data system design and sustainability. The chapter then concludes with a discussion of the criteria for health care policy “success”.

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Decolonizing the U.S. Health Care System: Undocumented and Disabled after ACA

Health Tomorrow: Interdisciplinarity and Internationality ◽

10.25071/2564-4033.40230 ◽

2018 ◽

Vol 5 ◽

Author(s):

Lisa Sun-Hee Park ◽

Anthony Jimenez ◽

Erin Hoekstra

Keyword(s):

Health Care ◽

Health Care System ◽

Low Income ◽

Health Care Access ◽

Undocumented Immigrants ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Original Research ◽

The U.S ◽

Care System

The Affordable Care Act (ACA) explicitly denies newly arrived documented and undocumented immigrants health insurance coverage, effectively making them the largest remaining uninsured segment of the U.S. population. Using mixed qualitative methods, our original research illustrates the health consequences experienced by uninsured, disabled undocumented immigrants as they navigate what they describe as an apartheid health care system. Critiquing the notion of immigrants as “public charges” or burdens on the system, our qualitative analysis focuses on Houston Health Action, a community-based organization led by and for undocumented, low-income disabled immigrants in Houston, Texas. Engaging a critical migration and critical disabilities studies framework, we use this valuable case to highlight contemporary contradictions in health care and immigration legislation and the embodied consequences of the intersecting oppressions of race, ability, immigration status, and health care access.

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The ecology of medical care: access points to the health care system in Austria and other developed countries

Scandinavian Journal of Primary Health Care ◽

10.1080/02813432.2019.1663593 ◽

2019 ◽

Vol 37 (4) ◽

pp. 409-417 ◽

Cited By ~ 1

Author(s):

Kathryn Hoffmann ◽

Robin Ristl ◽

Aaron George ◽

Manfred Maier ◽

Otto Pichlhöfer

Keyword(s):

Health Care ◽

Medical Care ◽

Health Care System ◽

Developed Countries ◽

Access Points ◽

Care Access ◽

Care System

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The second sputum sample complicates tuberculosis diagnosis for women: a qualitative study from Malawi

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.17.0146 ◽

2017 ◽

Vol 21 (12) ◽

pp. 1258-1263

Author(s):

M. Kumwenda ◽

B-T. Nyang'wa ◽

B. Chikuse ◽

T. Biseck ◽

S. Maosa ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Access ◽

Sputum Sample ◽

Care Facility ◽

Health Care Facility ◽

Health Care Facilities ◽

System Level ◽

Diagnostic Process ◽

Care System

SETTING: District hospital and peripheral health care facilities in Balaka District, Malawi.OBJECTIVE: To identify barriers encountered by women in submitting a second sputum sample.DESIGN: Focus-group discussions and semi-structured interviews.RESULTS: Women encounter barriers at several levels: personal, cultural, socio-economic and health care system. Personal, cultural and socio-economic barriers include the fear of a tuberculosis (TB) diagnosis, the perception and condition of the patient, the distance and cost of travel to a health care facility, the subordinate position of women in household decision-making and the social support that women receive. Barriers at the health care system level include high patient numbers, staff shortages, the duration of the TB diagnostic process as well as the uncaring attitude and poor communication of health care workers. These barriers may apply not only to the submission of the second sample, but to health care access in general.CONCLUSION: Women face multiple barriers in submitting a second sputum sample. These do not operate in isolation but instead compound each other. Although potential solutions to overcome these barriers are recognised, some have yet to be adopted. To improve TB case finding, innovative and community approaches should be adopted more rapidly.

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Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

Perspectives on Telepractice ◽

10.1044/teles4.1.23 ◽

2014 ◽

Vol 4 (1) ◽

pp. 23-29

Author(s):

Constance Hilory Tomberlin

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Patient Care ◽

Health Care System ◽

Gulf Coast ◽

New Technology ◽

Cost Effective ◽

Veterans Health ◽

Potential Benefits ◽

Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

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