title: Insurance + access not equal to health care: typology of barriers to health care access for low-income families.
abstract: OBJECTIVE
  Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.
  
  
  METHODS
  A mixed methods analysis was undertaken using 722 responses to an open-ended question on a health care access survey instrument that asked low-income Oregon families, "Is there anything else you would like to tell us?" Themes were identified using immersion/crystallization techniques. Pertinent demographic attributes were used to conduct matrix coded queries.
  
  
  RESULTS
  Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families.
  
  
  CONCLUSIONS
  Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.
authors.affiliation: Oregon Health and Science University, Department of Family Medicine, Portland, Ore, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Devoe
authors.forename: Alia
authors.initials: A
authors.lastname: Baez
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.forename: Lisa
authors.initials: L
authors.lastname: Krois
authors.forename: Christine
authors.initials: C
authors.lastname: Edlund
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009922:Oregon; D011050:Policy Making; D011203:Poverty; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations / Q000706:statistics & numerical data*