Sharat P Iyer1, Andrea Jones2, Efrain Talamantes3, Elizabeth S Barnert4, Hemal K Kanzaria5, Alissa Detz6, Timothy J Daskivich4, Loretta Jones2, Gery W Ryan7, Anish P Mahajan8. 1. 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 2. VISN3 Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY ; 3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York. 2. 4. Charles R. Drew University of Medicine and Science, Los Angeles ; 5. Healthy African American Families, Los Angeles. 3. 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles. 4. 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles. 5. 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 7. Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles ; 8. VA Greater Los Angeles Healthcare System. 6. 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles. 7. 10. Los Angeles County Department of Health Services. 8. 10. Los Angeles County Department of Health Services ; 11. Division of General Internal Medicine and Health Service Research, University of California, Los Angeles.
Abstract
OBJECTIVE: 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.
OBJECTIVE: 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.
Entities:
Keywords:
Community Health Services; Health Services Accessibility; Medically Uninsured; Patient Protection and Affordable Care Act
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