title: Identifying patient, community and program specific barriers to free specialty care utilization by uninsured patients in East Baltimore.
abstract: Uninsured individuals face multiple barriers to accessing specialty care. The Access Partnership (TAP) offers free specialty care and care coordination to qualified uninsured patients at an urban academic medical center for a small program entry fee (waived for financial hardship). In the program's first year, 104 eligible patients (31%) did not enroll. To understand why, we investigated demographic, referral, personal, and program-specific factors. After adjusting for age, gender, and ZIP code, diagnostic and therapeutic referrals were more likely to be completed than ancillary referrals (OR=8.56, p=.001; OR 3.53, p=.03). There was no difference between pain related and ancillary referrals (OR=2.80, p=.139). Eighteen patients were surveyed and reported program and patient-specific barriers. While removing costs is necessary to improve access to specialty care for underserved patients, it is insufficient. Improving communication from program coordinators and enrollment strategies may help to improve utilization of free care programs by the uninsured.
authors.affiliation: Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Handy
authors.forename: Sai
authors.initials: S
authors.lastname: Ma
authors.forename: Lauren
authors.initials: L
authors.lastname: Block
authors.forename: Desiree
authors.initials: D
authors.lastname: de la Torre
authors.forename: Anne
authors.initials: A
authors.lastname: Langley
authors.forename: Barbara
authors.initials: B
authors.lastname: Cook
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000293:Adolescent; D000328:Adult; D000368:Aged; D015142:Baltimore; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008511:Medicine / Q000458:organization & administration; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation / Q000458:organization & administration*; D012959:Socioeconomic Factors; D055815:Young Adult