TY - JOUR
T1 - Improving health care for the future uninsured in Los Angeles County
T2 - A community-partnered dialogue
AU - Iyer, Sharat P.
AU - Jones, Andrea
AU - Talamantes, Efrain
AU - Barnert, Elizabeth S.
AU - Kanzaria, Hemal K.
AU - Detz, Alissa
AU - Daskivich, Timothy J.
AU - Jones, Loretta
AU - Ryan, Gery W.
AU - Mahajan, Anish P.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Objectives: To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue. Design: Qualitative study using a community-partnered participatory research framework. Setting: Community forum breakout discussion. Discussants: Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district. Main Outcome Measures: Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes. Results: Five overarching value themes were identified - knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality. Conclusions: Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations.
AB - Objectives: To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue. Design: Qualitative study using a community-partnered participatory research framework. Setting: Community forum breakout discussion. Discussants: Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district. Main Outcome Measures: Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes. Results: Five overarching value themes were identified - knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality. Conclusions: Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations.
KW - Community Health Services
KW - Health Services Accessibility
KW - Medically Uninsured
KW - Patient Protection and Affordable Care Act
UR - http://www.scopus.com/inward/record.url?scp=84962754493&partnerID=8YFLogxK
U2 - 10.18865/ed.25.4.487
DO - 10.18865/ed.25.4.487
M3 - Article
C2 - 26675541
AN - SCOPUS:84962754493
SN - 1049-510X
VL - 25
SP - 487
EP - 494
JO - Ethnicity and Disease
JF - Ethnicity and Disease
IS - 4
ER -