title: Navigating the health care system: a view from the urban medically underserved.
abstract: OBJECTIVE
  The purpose of this project was to discover areas identified by minority and underserved patients that lead to dissatisfaction with the health care system and specific areas identified as barriers to health.
  
  
  METHODS
  Six focus groups (n=25) were conducted, with participants including mostly poor African-American adults with and without a primary care home, in addition to 1 group of community dwelling mentally ill patients, and 1 group of case managers for community dwelling mentally ill patients who navigate the health care system for their clients. Qualitative analysis by 3 authors identified themes emerging from the focus groups.
  
  
  RESULTS
  The following themes were identified: (1) difficulty with insurance, including coverage, accessibility, stability, and choices; (2) socioeconomic, more than racial, barriers to care; (3) a misunderstanding or lack of information about the health care system and a lack of health literacy; and (4) lack of personal accountability for health and health care.
  
  
  CONCLUSIONS
  Patients with access to a primary care home seemed more satisfied with the health care system. An increase in health literacy education and simplification of insurance policies and procedures could increase satisfaction and possibly improve outcomes for underserved patients. Providing preventive care and improving patient accountability for personal health may also improve satisfaction and outcomes.
authors.affiliation: Aurora Family Care Center, 1020 N 12th St, Suite 202, Milwaukee, WI 53233, USA. liz.bade@aurora.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bade
authors.forename: Jennifer
authors.initials: J
authors.lastname: Evertsen
authors.forename: Sabrina
authors.initials: S
authors.lastname: Smiley
authors.forename: Indrani
authors.initials: I
authors.lastname: Banerjee