Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients  

作　　者：James J.Werner Kitty K.Corbett 

机构地区：[1]Department of Family Medicine and Community Health,Mandel School of Applied Social Sciences,Case Western Reserve University,11000 Cedar Avenue,Suite 402,Cleveland,OH 44106,USA [2]School of Public Health and Health Systems,University of Waterloo,200 University Avenue West,Waterloo,Ontario,N2L 3G1,Canada

出　　处：《Family Medicine and Community Health》2015年第3期18-24,共7页家庭医学与社区卫生（英文）

基　　金：the Clinical and Translational Science Collaborative of Cleveland,UL1TR000439 from the National Center for Advancing Translational Sciences component of the National Institutes of Health(NIH);the NIH Roadmap for Medical Research,by Case Comprehensive Cancer Center Support Grant P30CA43703-23 from the National Cancer Institute of the NIH,and by the Centers for Primary Care Practice-Based Research and Learning from the Agency for Healthcare Research and Quality through grant P30HS021648-03.

摘　　要：Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients.Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct observations.We captured additional data by studying cases of referred uninsured patients.Results:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured patients.Conclusion:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.

关 键 词：Health services accessibility barriers to health care medically uninsured health care inequities access to specialty care qualitative methods 

分 类 号：R73[医药卫生—肿瘤]