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首页> 美国卫生研究院文献>Journal of Clinical and Translational Science >2250 Barriers to healthcare after the Affordable Care Act: A qualitative study of Los Angeles safety net patients’ experiences with insurance and healthcare
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2250 Barriers to healthcare after the Affordable Care Act: A qualitative study of Los Angeles safety net patients’ experiences with insurance and healthcare

机译：负担得起的医疗法案之后的2250个医疗障碍：对洛杉矶安全网患者的保险和医疗经验的定性研究

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OBJECTIVES/SPECIFIC AIMS: N/A. METHODS/STUDY POPULATION: Over a million people gained insurance in Los Angeles (LA) County under the Affordable Care Act (ACA). The vast majority gained Medicaid—government sponsored insurance with low-cost sharing. LA County also made significant investments in the safety net including a program called MyHealthLA, which provides primary and tertiary care for the residually uninsured including poor undocumented individuals at specific sites. Despite this insurance expansion, approximately 3 quarters of a million people in the county remain uninsured. Regardless of insurance status, nearly a quarter of LA County residents reported having difficulty obtaining needed medical care, and among those making less than the poverty level, 43% had difficulties. There is still much to understand about barriers to obtaining insurance and accessing healthcare in Los Angeles in the post-ACA era. Our primary objective was to understand how safety net patients are obtaining, maintaining and using their insurance after the ACA. Specifically we hope to understand the barriers and drivers of these three processes. RESULTS/ANTICIPATED RESULTS: We conducted a qualitative study of 34 safety net patients with 3 different insurance types in LA County. We conducted in-person interviews with adult patients (ages 18–64 years), who had either MediCal, MyHealthLA, or were unsinsured. Our interview guide was based on existing literature, a previous qualitative study conducted in Massachusetts and input from experts in the field. We pilot tested our interviews in English and Spanish and then recruited our participants from 3 sites: LAC+USC (a publically funded county hospital), The Wellness Center (a resource center for safety net patients), and White Memorial Medical Center (a private safety net hospital). We approached patients in the ED and urgent care waiting rooms and obtained informed consent for this IRB approved study. We excluded patients who were non-English and non-Spanish speaking or too ill to interview. We recorded interviews, which were then transcribed and translated into English by a contracted agency. We analyzed our interviews using a framework approach, which included a set of a priori codes from the literature as well as emerging codes from patient responses. We will check a sample of our transcripts for coding consistency (aiming for an inter-rater reliability of >80%). DISCUSSION/SIGNIFICANCE OF IMPACT: We recruited a diverse group of patients that were demographically representative of those who gained insurance under the ACA (childless adults making less than 138% of the Federal Poverty Level). Our preliminary results (based on 17 transcripts), suggest that patients, regardless of insurance type have difficulty accessing primary care. We identified seven domains under the broader theme of barriers to accessing primary care: finding a primary care clinic or physician (PCP), getting timely appointments, geography and transportation, continuity of care, using the Emergency Department (ED) or urgent care as a PCP, switching PCPs or clinics, and cost or coverage.
机译：目标/特定目的：不适用。方法/研究人群：根据可负担医疗法案（ACA），超过一百万的人在洛杉矶（LA）县获得了保险。绝大多数人获得了医疗补助-政府赞助的低成本共享保险。洛杉矶县还对安全网进行了重大投资，其中包括一项名为MyHealthLA的计划，该计划可为残障人士（包括特定地点的无证个人）提供初级和三级护理。尽管扩大了保险范围，该县约有四分之三的百万人口仍未投保。不论保险状况如何，洛杉矶县近四分之一的居民都表示难以获得所需的医疗服务，而那些收入低于贫困线的居民中，有43％的人有困难。在后ACA时代，在洛杉矶获得保险和获得医疗保健的障碍还有很多要理解。我们的主要目标是了解ACA之后安全网患者如何获得，维持和使用其保险。具体来说，我们希望了解这三个过程的障碍和驱动因素。结果/预期结果：我们对洛杉矶县的34种具有3种不同保险类型的安全网患者进行了定性研究。我们对成年患者（年龄在18-64岁之间）患有MediCal，MyHealthLA或未投保的患者进行了亲自访谈。我们的采访指南基于现有文献，先前在马萨诸塞州进行的定性研究以及该领域专家的意见。我们试点用英语和西班牙语测试了我们的采访，然后从3个地点招募了参与者：LAC + USC（公立县医院），健康中心（安全网患者资源中心）和White Memorial Medical Center（私人诊所）安全网医院）。我们在急诊室和急诊候诊室就诊，并获得了IRB批准的这项研究的知情同意。我们排除了非英语和非西班牙语或病情不佳的患者。我们记录了采访内容，然后由一家签约代理商将其转录并翻译成英文。我们使用框架方法分析了访谈，其中包括文献中的一组先验代码以及患者反应中出现的新代码。我们将检查笔录样本中的编码一致性（以评估者间的可靠性> 80％为目标）。讨论/意义：我们招募了一组不同的患者，这些患者在人口统计学上代表了通过ACA获得保险的那些人（无子女的成年人，其收入低于联邦贫困水平的138％）。我们的初步结果（基于17个笔录）表明，无论保险类型如何，患者都难以获得初级保健。我们在获得初级保健的障碍这一更广泛主题下确定了七个领域：寻找初级保健诊所或医生（PCP），及时预约，地理和交通，护理的连续性，使用急诊科（ED）或紧急护理作为PCP，交换PCP或诊所以及费用或承保范围。

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