title: A study of women prisoners' use of co-payments for health care: issues of access.
abstract: OBJECTIVE
  We sought to analyze women prisoners' use of co-payments for health care; how co-payments affect their access to health care; and how they view the impact of co-payments on their health.
  
  
  METHODS
  Using a community-based participatory research approach, we conducted six focus groups with 31 previously incarcerated women. Data were analyzed using qualitative field research methods, grounded theory, and consensual qualitative research strategies to construct a shared understanding of the data.
  
  
  RESULTS
  Co-payments hindered women prisoners' access to health care. Women reported inequitable implementation of the policy and foregoing care because of the financial burden of the co-payment. Co-payments contributed to delays in treatment, avoidance of health care professionals, unnecessary suffering, and poor health outcomes. In response, women used self-advocacy skills to manage their health care needs and deal with the prison health care system.
  
  
  CONCLUSIONS
  Co-payments place an unfair burden on prisoners who are poor, limit access to health care, and contribute to needless suffering and potentially to preventable deaths.
authors.affiliation: San Francisco State University, School of Nursing, San Francisco, California 94132, USA. anastasf@sfsu.edu
authors.forename: Anastasia A
authors.initials: AA
authors.lastname: Fisher
authors.forename: Diane C
authors.initials: DC
authors.lastname: Hatton
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003669:Deductibles and Coinsurance; D005260:Female; D017144:Focus Groups; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics; D006296:Health Services / Q000191:economics / Q000592:standards; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction / Q000191:economics*; D011329:Prisoners; D011330:Prisons / Q000191:economics; D036301:Qualitative Research; D011787:Quality of Health Care; D014481:United States; D055815:Young Adult