title: Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
abstract: BACKGROUND
  Insurance coverage alone does not guarantee access to needed health care. Few studies have explored what "access" means to low-income families, nor have they examined how elements of access are prioritized when availability, affordability, and acceptability are not all achievable. Therefore, we explored low-income parents' perspectives on accessing health care.
  
  
  METHODS
  In-depth interviews with a purposeful sample of 29 Oregon parents who responded to a previously administered statewide survey about health insurance. Transcribed interviews were analyzed by a multidisciplinary team using a standard iterative process.
  
  
  RESULTS
  Parents highlighted affordability and limited availability as barriers to care; a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children. We present a new conceptual model to explain these experiences accessing care with health insurance: the Optimal Care Model. The model shows a transition from optimal care to a breaking point where affordability becomes the driving factor, but the care is perceived as unacceptable because it is with an unknown provider.
  
  
  CONCLUSIONS
  Even when covered by health insurance, low-income parents face barriers to accessing health care for their children. As the Affordable Care Act and other policies increase coverage options across the United States, many Americans may experience similar barriers and facilitators to health care access. The Optimal Care Model provides a useful construct for better understanding experiences that may be encountered when the newly insured attempt to access available, acceptable, and affordable health care services.
authors.forename: Heather
authors.initials: H
authors.lastname: Angier
authors.forename: Jessica
authors.initials: J
authors.lastname: Gregg
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.forename: Courtney
authors.initials: C
authors.lastname: Crawford
authors.forename: Melinda
authors.initials: M
authors.lastname: Davis
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000191:economics; D003657:Decision Making; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics; D007407:Interviews as Topic; D017057:Medically Uninsured / Q000706:statistics & numerical data; D009922:Oregon; D010290:Parents / Q000523:psychology*; D058991:Patient Protection and Affordable Care Act; D011203:Poverty / Q000191:economics; D036301:Qualitative Research