title: "I want you to save my kid!": Illness management strategies, access, and inequality at an elite university research hospital.
abstract: Using data drawn from interviews and observations with 18 families whose children were diagnosed with life-threatening, often rare diseases, I examine how families accessed and negotiated medical care at a top 10-ranked university research hospital. Access to highly specialized and technologically advanced care was essential in these critical cases. Combining analysis of these high-stakes cases with recent work highlighting the interactional dynamics of care delivery, I show how families followed different paths to elite care and used different illness management strategies throughout the treatment process depending on their ability to mobilize what Janet Shim terms cultural health capital. These diverging illness management strategies reproduced inequality even at the top of the U.S. healthcare system by allowing some families to secure microadvantages throughout the illness experience. These findings suggest a complex interplay between structures of care delivery and families' illness management strategies and point to the need for broader conceptualizations of healthcare advantages.
authors.affiliation: Department of Sociology, Wake Forest University, Winston Salem, NC, USA gengleam@wfu.edu.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Gengler
mesh_terms: D002648:Child; D016638:Critical Illness; D019468:Disease Management; D005190:Family / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006785:Hospitals, University; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011368:Professional-Family Relations; D066270:Social Capital; D014481:United States
keywords: cultural health capital; families; healthcare inequality; illness management strategies; microadvantages